Inspection·January 27, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 01/26/23 at 2:49 PM, an interview was conducted with Staff I, RN who was apprised that on 01/24/23 she called Resident #352 a feeder. Staff I stated she should of said needs assistance with feeding, not call the resident a feeder. 2) Review of Resident #58's clinical record revealed an admission to the facility on [DATE] with no readmissions. The resident's diagnoses included Heart Failure, Psychosis, Depression, Chronic Obstructive Pulmonary Disease (COPD), Chronic Kidney Disease and Head Injury. Review of Resident #58's Minimum Data Set (MDS) admission assessment, dated 12/24/22 documented a Brief Interview of the Mental Status (BIMS) score of 0 indicating that the resident had severe cognition impairment. The assessment documented under, Functional Status that the resident was total dependent on the staff for all her activities of daily living including eating. On 01/24/23 at 12:18 PM, during dining observation on the facility's 2-East Unit, observation revealed the facility's Director of Nursing (DON) passing residents lunch trays. The Surveyor asked the DON for Resident #58's tray and the DON stated the tray was in the cart because Resident #58 was as feeder. The DON was asked what the resident was, and the DON stated again, the resident was a feeder. On 01/26/23 at 8:02 AM, observation revealed Resident #58 in bed being set up by Staff L, CNA. During an interview, Staff L stated the resident cannot feed herself and needed assistance with feeding. On 01/27/23 at 8:15 AM, during an interview, the DON was apprised of labeling Resident #58 and #325 as feeders. The DON stated No, I did not do that. The DON was informed she repeated multiple times. The DON stated that she should not have called the residents feeders. 3. Record review revealed Resident #67 was admitted to the facility on [DATE] with diagnoses of Dementia and Dysphagia. The Minimum Data Set (MDS) assessment dated [DATE] under section G for eating showed that she needs extensive assistance with one person assist. Record review revealed Resident #83 was readmitted to the facility on [DATE] with diagnoses of Dementia and Dysphagia. The Minimum Data Set (MDS) assessment dated [DATE] under section G showed the resident needs extensive assistance with one person assist for eating. In an observation conducted on 01/25/23 at 8:10 AM, revealed the meal cart arrived on the west unit. Resident #67 and #83's breakfast trays were noted inside the meal cart. Staff D, Certified Nursing Assistant (CNA), was observed walking toward the meal cart and opening the door. She looked at the meal tickets and asked Staff G, Certified Nursing Assistant (CNA) if she should take the trays into Resident #67 and Resident #83' rooms. Staff G said, no, wait with these trays; they are feeders. A few minutes later, Staff E walked towards Staff D and asked her about Resident #67 and Resident #83's breakfast trays. Staff D then said to Staff G, They are feeders, and continued to pass other breakfast trays. In an interview conducted on 01/27/23 at 9:52 AM, Staff D was asked if it is okay to use the word feeders, when referring to residents who need assistance with dining. Staff D said that she should not have used that word when she asked about Resident #67 and Resident #83 breakfast trays the day before. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 2 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 1 (Second Floor) of 2 resident living areas. The findings include: During the initial resident screenings conducted on 01/24/23 and the Environment Tour conducted on 01/25/23 at 1 PM accompanied with the Administrator and Director of Maintenance, the following concerns were noted: Second Floor: room [ROOM NUMBER] - Room wall noted to be in disrepair and numerous large black scuff marks; exterior of room chairs were heavily worn; and exterior of end table (A bed) was worn with exposed sharp wood. room [ROOM NUMBER] - Room floor heavily soiled with noted large black stain marks, and exterior of end table (A -bed) was in despair. room [ROOM NUMBER] - Privacy curtain (A-bed) noted to be heavily stained and soiled, exterior of room chair was heavily worn, and exterior of over-bed table (B-bed) was soiled. room [ROOM NUMBER] - Room walls noted to be in disrepair and numerous large black scuff marks, and over-bed light cords missing (A & B beds). room [ROOM NUMBER] - Over-bed light pull cords missing (A & B beds). room [ROOM NUMBER] - The cushion of the room chair noted to have large tears. room [ROOM NUMBER] - Room wall noted to be in disrepair and numerous large black scuff marks, and exterior of room chair was heavily worn. room [ROOM NUMBER] - Exterior of room chairs (2) were heavily worn and cushions were torn, and no over-bed light pull cord (A & B beds). room [ROOM NUMBER] - Room wall noted to be in disrepair and numerous large black scuff marks, and exterior of over-bed table was heavily worn and in disrepair (1). room [ROOM NUMBER] - Exterior of room chairs (2) were heavily worn and seat cushions were torn. room [ROOM NUMBER] - Room wall noted to be in disrepair and numerous large black scuff marks, and bathroom ceiling tiles (2) were heavily stained brown in color. room [ROOM NUMBER] - Exterior of room chairs (2) were heavily worn, and room ceiling tiles (3) were stained brown in color. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 3 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 0584 Level of Harm - Minimal harm or potential for actual harm room [ROOM NUMBER] - Room wall noted to be in disrepair and numerous large black scuff marks, bathroom call light cord was wrapped around the handrail, and no over-bed light pull cord (B bed). room [ROOM NUMBER] - Exterior of room chair was heavily worn, and no over-bed light pull cord (A & B beds). Residents Affected - Some room [ROOM NUMBER] - No over-bed light pull cord (A & B beds). room [ROOM NUMBER] - Room floors noted to be heavily soiled and black stain marks, the exterior of the dresser (A bed) noted to be in disrepair, and room wall noted to be in disrepair and numerous large black scuff marks. T. V. Room/Dining Room - Ceiling tiles (3) noted to be stained brown in color. Physical Therapy Room - Observation of the parallel bars (2) were noted to be not secured and shook from side to side. Bars need to be secured for resident safety and training. Following the 01/25/23 tour, all the findings were again confirmed with the Administrator. It was noted that the facility has a computer TELS system but is not in use for staff to document housekeeping/maintenance issues. The facility relies on maintenance/housekeeping logs located at the 3 nurses stations which are checked by maintenance staff throughout the day. It was further stated that staff are not documenting housekeeping/maintenance issues on the log sheets. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 4 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - 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 address weight loss and provide nutritional interventions in a timely manner for 3 of 8 sampled residents reviewed for nutrition (Residents #96, #58, and #36). Residents Affected - Few The findings included: A review of the facility's policy titled Nutrition Assessment, revised on 12/16/21, showed that a systematic approach will be used to optimize a resident's nutritional Status. The process includes identifying and assessing each Resident's nutritional status and risk factors, evaluating/analyzing the assessment information, developing and consistently implementing pertinent approaches, monitoring the effectiveness of interventions, and revising them as necessary. It further showed that the Director of Food and Nutrition Services/ designee provides follow-up visits at least quarterly for all residents or more often if necessary. The Resident's nutritional status is updated as it changes, but no less than quarterly. A review of the facility's policy titled Weights and Heights, revised on 08/16/22, showed that all residents are weighed within 24 hours of admission and weekly for four weeks and as needed after that or more as determined by the RAR committee and physician order. The Resident's height is measured on admission and annually. 1) Observation conducted on 01/24/23 at 12:30 PM, noted a lunch tray placed in front of Resident #96. Continued observation over the next 30 minutes noted resident to be confused, unable to eat independently and not eating. The Surveyor observed no assistance or supervision from nursing staff. It was further noted that Fortified Food was not documented on the meal tray card and not included the on lunch tray (Fortified Mashed Potatoes). The resident consumed less than 10 % of lunch meal. Observation conducted on 01/25/23 at 8:30 AM noted a breakfast tray placed in front of Resident #96 while in bed. Continued observation for the next 30 minutes noted resident with confusion, hard of hearing, not eating and not receiving assistance/supervision from nursing staff. The Fortified Foods was not documented on the meal tray card and not included on the breakfast tray (Pureed Fortified Hot Cereal). Resident #96 consumed less than 10% of the breakfast meal. Observation conducted on 01/25 /23 at 12:30 PM of the lunch meal noted a meal tray served to Resident #96 while in bed. Resident noted to be confused and not eating independently. Staff noted nor to be assisting and supervising during the meal. No Fortified Foods were documented on the meal tray card or served on the lunch tray. Resident consumed less than 10 % of the meal. Observation conducted on 01/26/23 at 8:30 AM of the breakfast meal noted the tray placed in front of Resident #96. Resident noted not to be self feeding. Resident noted to ask the surveyor for help with eating and the surveyor informed nursing staff of the request, and staff was then observed to be in the room assisting the resident with the meal. Noted meal intake to be 50-75%. No Fortified Foods were included on the breakfast tray. Review of the current Snack List revealed the resident's name was not included. Review of the clinical record of Resident #96 noted the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 5 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Date Of admission: [DATE] Level of Harm - Minimal harm or potential for actual harm Diagnoses: Pneumonia, Hypokalemia, Dysphagia, and Reflux Current Physician Orders noted the following: Residents Affected - Few 11/30/22 - Fortified Foods All Meals 12/15/22 - Purred Diet 01/09/23 - House Shake TID (Three times daily) 01/09/23- Dietary Consult for Weight Loss Resident #96 Weight History: 01/24/23 = 110# (Pounds) 01/10/23 = 108# 12/27/22 = 111# 12/02/22 = 127# 12/01/22= 129# Weight Loss = 19 pounds (14.74%) MDS (Minimum Data Set) assessment: Dated 12/25/22 Sec B: Understands & Understood Sec C: BIMS (Brief Interview for Mental Status) score = 14, (Intact cognition) Sec D: No Mood Sec G : Eating = Limited Assist Sec K : 63/111#/ Mechanically Altered Diet Further review of clinical record for Resident #96 and review of Dietary Progress Notes noted the following: 1) There was no documentation in the record that a weight loss consultation was conducted by the facility Dietitian, as per the 01/09/23 physician order . 2) Review of 01/06/23 Weight Change Note documented - weight is down 8 pounds in 30 days. PO (by mouth) intake insufficient and hearing difficulty answering dietary questions. No Pressure Ulcer wound report .Recommend snacks for additional calories BID (twice daily) and Fortified Meals. Continue to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 6 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 monitor and intervene as clinically indicated. Level of Harm - Minimal harm or potential for actual harm Interview conducted with the facility's Consultant Dietitian conducted on 01/26/23 at 10 AM noted that she only is in the facility for eight hours once per week. She further stated that she was not made aware of the physician's order dated 01/09/23 for a dietary consult for weight loss, and further stated that there is no system in place for notification . Further interview noted that the recommendations of the 01/06/23 of Fortified Foods with all meals, and snacks BID was not followed through and the Fortified Foods and Snacks BID are not being served. She further stated that she does not follow through to ensure that dietary recommendations are being ordered and followed. Residents Affected - Few Review of the resident snack list for 10 AM, 2 PM, and HS (hour of sleep) snacks was conducted by the surveyor with the Consultant Dietitian and Dietary Manager (DM) on 01/26/23 noted that Resident #96 was not listed of the list for snacks to be provided twice per day. It was also confirmed that Fortified Foods were not documented of the resident's Breakfast, Lunch, and Dinner meal tray tickets. The DM stated that he was not informed of the Dietitian's order. 2) Review of Resident #58's, clinical record documented an admission date to the facility on [DATE] with no readmissions. The resident's diagnoses included Heart Failure, Psychosis, Depression, Chronic Obstructive Pulmonary Disease (COPD), Chronic Kidney Disease and Head Injury. Review of Resident #58's Minimum Data Set (MDS) admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 0, indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident was total dependent on the staff for all her activities of daily living, including eating. Review of Resident #58's care plan titled, The resident has nutritional problem related to a diagnosis of Weakness, History of Gastritis, and Dementia, initiated on 12/22/2022. The care plan interventions included Observe for and report to MD (Medical Director), as needed signs and symptoms of malnutrition: Emaciation (Cachexia),muscle wasting, significant weight loss: 3lbs in 1 week, greater than 5% in 1 month, greater than 7.5% in 3 months, greater than 10% in 6 months . Provide and serve supplements as ordered . RD (Registered Dietitian) to evaluate and make diet change recommendations as needed . Review of Resident #58's clinical record documented the following weight history: 01/24/23- 148.7 Lbs. 01/18/23- 151.0 Lbs. 01/10/23- 158.4 Lbs. 01/03/23- 162.2 Lbs. 12/22/22- 161.8 Lbs. 12/21/22- 163.5 Lbs. 12/20/22- 162.8 Lbs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 7 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #58's Nutrition: Assessment/Nutritional Data Collection completed by the facility's Dietary Technician Registered (DTR) on 12/22/22 and reviewed by the Consultant Registered Dietitian on 12/23/22 documented that Resident #58's estimated energy needs were between 1725 to 1875 calories a day. Resident #58's proteins needs were estimated between 75 grams to 85 grams a day. Review of Resident's #58's meals intake documented by the facility's Certified Nursing Assistant (CNAs) between 01/20/23 to 01/25/23 shows the following: Out of 21 meals consumed, the resident had an average of 45% of her intake. The house shakes recommended by the DTR three times a day was providing an additional 35% of estimated caloric needs and 23% of estimated protein needs. An average intake of meals with recommended supplement provided only 80% of Resident #58's estimated energy needs and 68% of estimated protein needs. Review of Resident #58's Nutrition: Assessment/Nutritional Data Collection dated 12/22/22 completed by the facility's DTR and reviewed by the facility's Consultant Dietitian on 12/23/22 documented .1725-1875 Kcal/Day (estimated energy needs) .75-89 Grams/Day estimated protein needs) .Continue to f/u (follow up) making any necessary recommendations . Review of Resident #58's Nutrition/Dietary Note dated 01/20/23 documented .Current weight: 151lb. Weight is down 7.4# x 7 days .PO intake varied per EMR (electronic medical record) .Will recommend house shake with meals to provide additional calories, minimize risks of weight loss. Recommend continue dietary orders and approaches. Will continue to monitor PO intake of meals, weight changes, skin integrity, and nutrition related labs as available in need of further interventions. RD intervene as clinically indicated, remain available PRN. Review of Resident #58's physician orders dated 01/23/23 for House Shakes with meals. Review of the Resident #58's January 2023 Medication Administration Record (MAR) documented House Shakes were started on 01/23/23, three days later after the Dietary Technician recommendations. On 01/24/23 at 10:38 AM, observation revealed Resident #58 in her room. The resident had gross ankle edema. The Surveyor attempted to interview the resident, however, she did not answer any questions asked. On 01/26/23 at 9:32 AM, a side by side review of Resident #58's clinical record was conducted with the Consultant Registered Dietitian (CRD). The CRD stated that the resident's initial weight was 162.8 lbs. and had an 8.5% weight lost in 30 days which was a significant weight loss. The CRD stated she was not aware of the resident's weight loss. The CRD stated that her note dated 01/20/23 recommended house shakes with meals. The CRD stated the resident should have been assessed due to the significant weight loss and stated that she did not see an assessment related to the weight loss. On 01/26/23 at 10:20 AM, an interview was conducted with Staff J, Restorative Aide (RA) who stated she believes Resident #58 has been weighed weekly. Staff J stated that she was able to see when a resident had a significant weight loss and would tell the DTR. Staff J stated that resident's on weekly weights are done on Saturdays. On 01/26/23 10:30 AM, an interview was conducted with Staff K, RA who stated that the residents weight readings are documented in the log and the log which is placed in their office drawer. Staff K added that the DTR then picks the log up and enters the readings in the residents record. Staff K stated she does not call the DTR or tells nursing of residents significant weight change. The readings (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 8 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 will be look at by the DTR. Level of Harm - Minimal harm or potential for actual harm On 01/26/23 at 2:21 PM, an interview was conducted with the facility's Dietary Technician Registered (DTR) who stated she completed Resident #58's Nutritional assessment/ admission assessment on 12/22/22. She stated the resident had edema in the lower extremities. The DTR stated residents weights are kept upstairs in a drawer in an office. The DTR added she retrieves the weight and in put them in the (computer) system. The DTR stated she adds interventions, or supplements when there is significant weight loss. The DTR stated the facility had a meeting every Thursday to discuss residents weights. The DTR stated she writes a recommendation sheet and give it to nursing and nursing will put the order in. The DTR stated Resident #58 was put on house shakes with all meals on 01/23/23. The DTR stated that the CRD recommended house shakes on 01/20/23 and added that the CRD at the end of her shift she will e-mail recommendations to nursing, DTR and Food Services Manager. The DTR was asked why Resident #58's House Shakes were not started until 01/23/23. The DTR stated that they (nursing unit managers) are not in the facility on the weekends. The DTR stated she was not aware of Resident #58's weight loss. The DTR stated because of the weight loss she will need to order fortified food and request an appetite stimulant. Residents Affected - Few On 01/27/23 at 10:58 AM, an interview was conducted with Staff I, Registered Nurse (RN). Staff I stated that the facility had a team of staff that goes over the residents weights. 3. A record review showed that Resident #36 was admitted to the facility on [DATE] with diagnoses of Anemia, Anxiety, and Depression. The Minimum Data Set (MDS) dated [DATE] showed that Resident #36 had a Brief Interview of Mental Status (BIMS) score of 13, which is cognitively intact. An interview conducted on 01/24/23 at 11:40 AM with Resident #36 stated that she lost some weight because she was very anxious with her previous roommate, who had Dementia. She further said that the noise and the screaming were too much for her, and she had Anxiety and could not eat. In an interview conducted on 01/24/23 at 1:00 PM, Resident #36 was in her room with the lunch tray that just came into her room. Closer observation showed that she ate about 50% of her lunch meal. A review of the weight log showed that on 04/02/22, Resident #36's weight was noted at 135.8 pounds. On 09/09/22, the weight was noted at 129.2 pounds, and on 12/27/22, it was at 121.8 pounds. A 14-pound total weight loss was noted from 04/02/22 to 12/27/22. Another weight was taken on 01/24/22, which showed that Resident #36 was at 120.2 pounds. A review of the Nutrition Quarterly assessment dated [DATE] showed the following: Resident #36 weight was documented at 126 pounds and not the correct weight of 121.8 pounds. It further showed that Resident #36's Usual Body Weight Range is between 126 pounds to 131 pounds. In this note, Staff B stated that Resident did not have any significant weight changes and that her weight is stable. She failed to identify the weight loss and was further recommended to continue with the same plan of care. The continued review did not show any nutritional supplements that were recommended to aid with weight loss. The Care Plan showed that Resident #36 is at risk for weight fluctuation related to her current health status for nutritional decline and recent hospitalization. It further showed that Resident #36's annual review was noted with a weight of 138.4, which was on 02/28/22. The Care Plan showed that Resident #36 would have a stable weight through the review date and monitor the intake of meals. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 9 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview conducted on 01/26/23 at 9:07 AM, Staff A, Clinical Dietitian, stated that she started working in the facility this past December 2022. She comes to the facility once a week for 8 to 12 hours and works on a consultant basis. Staff A said that when she comes into the facility once a week, Staff B, Dietary Technician, provides her with a list of high nutritional-risk residents that are needed to be seen by her. Some residents considered at high risk are those on enteral feedings, patients with pressure ulcers, patients on dialysis if any, and residents with severe weight loss trends. Staff B attends the weight loss meeting once a week and is aware of any significant weight loss that is reported by staff. According to Staff A, they are two restorative staff who oversee taking the weights on all residents. The weights are then recorded on a piece of paper that is given to the nurses on the unit. All Initial Nutritional Consultations are completed within seven days of admission. Staff B will start the Initial Assessment, which will later be reviewed by Staff A before completing it. Staff A stated that she does not do any of the Quarterly assessments but will only make any follow-up notes on high-risk residents as needed. When asked what is considered significant weight loss, she stated that it is more than 5% for 30 days, 7.5% for 90 days, and more than 10% for 180 days. Staff A reported that for any residents who had significant weight loss, she would go to see them and makes the necessary changes to their food choices and supplements. For residents who are not able to communicate, she looks at the Certified Nursing Assistant's documentation for the percent of intake of meals. This will give her a better indication of how well the residents are eating. Staff A further said that after her recommendations, she expects the Nursing staff and Staff B to follow up on her advice. Since she is given a new list of residents to see every Friday, she needs to follow up on the residents she reviewed the week before. She further stated that the contract only allows her to be in the facility on Fridays and that she is only acting as an oversight for Staff B, and all needed follow up for the week are completed by Staff B. In an interview conducted on 01/26/23 at 10:25 AM, Staff B stated that she has been in this facility for seven months. She provides Staff A with a list of residents with a new wound, significant weight loss, residents on tube feeding, and any concerns she may have about other residents. For all residents who are newly admitted to the facility, she will try and complete their Initial Assessment as soon as possible. Staff B waits to complete all the Assessments after they are reviewed by Staff A on Fridays. Staff B further said that if she notices that a specific resident is losing weight, she will take a reweight to ensure that the weight is accurate. Staff B will speak to the nurse in charge regarding a possible appetite stimulant or nutritional supplement. When asked about the weight policy, she said that weights are taken on all new residents on the first three days, four weeks later, and monthly thereafter. She is in charge of completing the Quarterly assessments and the Annually assessments. The high-risk residents will have a monthly note that is done by Staff A, all nutritional recommendations are emailed to Nursing staff, as well as the weekly weights. Restorative staff is be provided with a list of the weekly weights and the monthly weights on Fridays. After completing the necessary weights, the list is given back to her, and she puts it into the electronic system. Staff B prints out the weekly weights on all residents and reviews any weight loss trends that need following. She then calculates the weight percent to identify any significant weight losses. In an interview with the Director of Nursing (DON) on 01/27/23 at 10:09 AM, she stated that the Dietitian's recommendations are emailed to her and the Assistant Director of Nursing, and they give them to the nursing staff on the floors and in the morning meetings. At times the recommendations are sent to her on Fridays, and she only gets them on Monday morning. Once it is provided to the nursing staff, the Unit Manager oversees implementing these recommendations. Staff B, Dietary Technician, works in the facility on a full-time basis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 10 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 and is here daily. Staff B will give all her recommendations to the Unit Manager as well. 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: 106047 If continuation sheet Page 11 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and chart review, the facility failed to follow the practitioner's orders for tube feeding for 1 of 2 sampled residents reviewed for tube feeding (Resident #4). The findings included: A review of the facility's policy titled, Enteral Nutrition's Therapy, revised on 08/25/22, showed the following: Verify the practitioner's order, including the patient's identifiers; prescribed route based on the enteral feeding tube tip's location; enteral feeding device; prescribed enteral formula; administration method, volume, and rate; and type, volume, and frequency of water flushes. A chart review showed that Resident #4 was readmitted to the facility on [DATE] with heart failure, Dysphagia, and Chronic Respiratory Failure diagnoses. An order dated 12/19/22 showed Jevity 1.0 (tube feeding formulary) at 75 ml (milliliters) times 20 hours on at Noon and off at 8:00 AM. The care plan dated 11/13/22 showed that Resident #4 depends on tube feeding and has a tracheostomy in place. In an observation conducted on 01/24/23 at 11:14 AM, Resident #4 was noted in his room with the tube feeding running at 75 ml (milliliter) an hour. Closer observation showed that it was started on 01/24/23 at 5 AM. The tube feeding was noted at the 900 ml mark out of a 1000 ml bottle. The tube feeding that began at 5 AM on 01/24/23 should have been at the 775 ml mark out of a 1000 ml capacity bottle if stopped at 8:00 AM as per Physician's tube feeding order. Another observation conducted on 01/24/23 at 12:45 PM showed Resident #4 in his room with the tube feeding bottle running at 75 ml an hour. Closer observation showed that it was started on 01/24/23 at 5 AM. The tube feeding was noted at the 900 ml mark out of a 1000 ml bottle. The tube feeding that began at 5 AM on 01/24/23 should have been at the 775 ml mark if it was stopped at 8:00 AM and at around 700 ml mark if it was started at 12:00 PM as per Physician's tube feeding order. In an observation conducted on 01/25/23 at 7:44 AM, Resident #4 was noted in his room with the tube feeding running at 75 ml (milliliter) an hour. Closer observation showed that it was started on 01/25/23 at 4 AM. The tube feeding was noted at the 850 ml mark out of a 1000 ml bottle. The tube feeding that started at 4 AM on 01/25/23 should have been around the 700 ml mark out of a 1000 ml capacity bottle. In an observation conducted on 01/26/23 at 8:45 AM, Resident #4 was in his bed with the tube feeding on hold. Closer observation showed that the tube feeding bottle was started on 01/26/23 at 2:00 AM. The tube feeding bottle was at the 700 ml mark out of a 1000 ml capacity bottle. The tube feeding bottle should have been at the 550 ml capacity bottle as per the Physician's orders. In an interview conducted on 01/26/23 at 11:00 AM, Resident #4's private caregiver stated that Resident #4 is tolerating his tube feeding well. She further said that the tube feeding was turned off at 8:00 AM this morning by staff. In an interview conducted on 01/27/23 at 12:10 PM, Staff F, Licensed Practical Nurse, stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 12 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #4 tolerates his tube feeding well. She further said that the tube feeding bottle was already running when she started this morning and that she turned it off at 8:00 AM and will resume the tube feeding at Noon. In an interview conducted on 01/27/23 at 1:00 PM with the facility's Administrator, she was told of the findings. Event ID: Facility ID: 106047 If continuation sheet Page 13 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to provide Tracheostomy care using a sterile technique for 1 of 1 sampled residents (Resident #4) reviewed for Respiratory Care. Residents Affected - Few The findings included: Review of the facility's policy/procedure provided by the Director of Nursing titled, Tracheostomy Tube Cannula and Stoma Care revised on 11/28/22 documented, .This procedure should be performed using sterile technique and includes cleaning the stoma, neck, cleaning or replacing the inner cannula .if you must replace the disposable inner cannula, open the package containing the new inner cannula while maintaining sterile technique . Review of Resident #4's clinical record documented an admission date to the facility on [DATE] with a readmission on [DATE]. The resident's diagnoses included Encounter for Attention To Tracheostomy, Encephalopathy, and Chronic Respiratory Failure. Review of Resident #4's physician orders dated 05/14/22 documented, Tracheostomy care every shift and as needed. Review of Resident #4's Minimum Data Set (MDS) Annual assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 0, indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident was total dependent on the staff for the activities of daily living, including tracheostomy care. Review of Resident #4's care plan titled Resident #4 has a tracheostomy related to ineffective breathing pattern initiated on 04/17/19 and revised on 05/0/19. The care plan interventions included change tracheostomy inner cannula week . On 01/26/23 at 8:25 AM, observation revealed Resident #4 in bed connected to 5 liters of oxygen via Tracheostomy tube. On 01/26/23 at 11:00 AM, observation of tracheostomy care performed by Staff F, a Licensed Practical Nurse (LPN) and assisted by Staff M, Registered Nurse (RN) was conducted. Observation revealed Staff F and Staff M, performed hand hygiene and donned non-sterile gloves. Observation revealed a clean field set up on the table that contained a tracheostomy care tray, a disposable cannula Shiley, one suction catheter, two gauze packages, oxygen mask and tracheostomy tube holder. Observation revealed Staff F removed Resident #4's oxygen mask and the inner tracheostomy cannula. Staff F removed the non-sterile gloves, performed hand hygiene and donned sterile gloves. Staff F proceeded to clean the Tracheostomy area, removed the sterile gloves, performed hand hygiene and then donned non-sterile gloves. Further observation revealed Staff F removed the disposable tracheostomy inner cannula from the package and placed it into tracheostomy opening. On 01/26/23 at 11:26 AM, an interview was conducted with Staff F who stated that she was supposed to assess Resident #4's lungs sounds before she started the procedure and did not do it. Staff F stated that she was supposed to use sterile gloves to insert the new cannula but used the sterile gloves to clean the area. Consequently, an interview was conducted with Staff M, who was assisting Staff F with the procedure. Staff M confirmed that Staff F used non-sterile gloves to insert the cannula (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 14 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 and was supposed to use sterile gloves. Level of Harm - Minimal harm or potential for actual harm On 01/27/23 at 7:57 AM, during an interview, the facility's Director of Nursing was apprised regarding tracheostomy care observation and failure to use a sterile technique while changing the inner cannula. The DON stated Staff F was supposed to use sterile gloves to insert the cannula. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 15 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to: 1) secure/lock the non-controlled substance e-kit located in the 2- [NAME] unit's medication storage room; 2) failed to remove an IV (intravenous) start kit with an expiration date on [DATE]; 3) failed to remove a Gastrostomy tube feeding with an expiration date of 09/2017 in the 1- [NAME] unit's medication storage room; and 4) failed to secure/lock 1 of 3 treatment carts located in the 2-East unit. The findings included: Review of the facility's policy provided by the Director of Nursing (DON) titled, Storage and Expiration Dating of Medications, Biologicals revised on [DATE] documented .facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room facility should destroy or return all .outdated, expired .medications and biologicals . 1) On [DATE] at 3:45 PM, a side by side review of the facility's 2-West Unit's medication storage room was conducted with the Director of Nursing (DON). The review revealed a combo kit box from the pharmacy that was not secured/locked. During the review, an interview was conducted with the DON who stated the combo kit contains antibiotics and other medications. Further review revealed the combo kit box had three inner trays with medications. Observation revealed one of the three trays was unlocked. The DON stated that the tray and the combo kit box was supposed to be locked. The DON stated the last time the combo kit was opened was on [DATE] by Staff F, Licensed Practical Nurse (LPN). A side by side review of the non-controlled substance E-kit withdrawal form documented that Cephalexin (antibiotic) 250 mg was removed from the box on [DATE]. The combo kit box contained medications that included antibiotics, heart medications, anticoagulants, diuretics, and antipsychotics. Review of Resident #302's clinical record documented a physician order dated [DATE] for Cephalexin 500 mg 1 tablet by mouth four times a day for prophylactic for 5 days. On [DATE] at 8:08 AM, an interview was conducted with Staff F, LPN who stated that on [DATE] she removed two Cephalexin 250 mg, for Resident #302. Staff F stated she got busy and forgot to lock the box afterwards. Staff F added she was supposed to locked with a red tag/string. A side by side review with Staff F of Resident #302's medication administration record was conducted. The review revealed that Staff F documented Cephalexin 500 mg given on [DATE]. On [DATE] at 10:31 AM, an interview was conducted with Staff M, RN who stated that once they removed a medication from the E-kit they had to lock the box, one lock to the trays inside and one lock to the outside. On [DATE] at 9:18 AM, an interview was conducted with the Unit Manager who stated that the nurses are supposed to lock the E-kit box after they remove something from it. 2) On [DATE] at 4:04 PM, a side by side review of the facility's 1-West Unit medication storage room was conducted with Staff O, Registered Nurse (RN). The review revealed one IV (intravenous) start kit with an expiration date on [DATE] and one Gastrostomy Feeding tube with expiration date on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 16 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 09/2017. Staff O confirmed the medical supplies were expired and removed them from the room. Level of Harm - Minimal harm or potential for actual harm 3) On [DATE] at 10:29 AM, observation revealed the facility's 2-East Unit treatment cart parked by the nurses station and facing the residents dining room. Further observation revealed the treatment cart was unlocked/unsecured. Observation revealed residents and visitors walking by the unlocked cart. Consequently, a side by side review of the treatment cart was conducted with Staff I, RN who noted and acknowledged that the treatment cart was unlocked. During the review, Staff I stated that she did not know who left it unlocked. Staff I stated the nurses get resident's medication/creams from the cart. A side by side review of the cart six drawer was conducted with Staff I. The cart contained multiple residents topical medications that included Diclofenac (pain gel), Clotrimazole (antifungal), Triamcinolone cream (antifungal), Nystatin powder (antifungal) and Bacitracin (antibiotic). Residents Affected - Few On [DATE] at 8:23 AM, an interview was conducted with the DON who was apprised of the observations and findings. The DON stated that the nurses use the IV start kit to start a peripheral IV line. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 17 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and review of policy and procedure, it was determined that the facility failed to ensure that it exercised due diligence with regard to not promptly addressing, reporting and following-up on the resident's dental concerns, in a timely manner for 1 of 2 sampled residents observed ( Resident #48). Residents Affected - Few The findings included: Review of the facility policy and procedure, titled Dental Services, provided by the Director of Nursing (DON), reviewed 08/18/22, documented in the Policy Statement: The facility is responsible for assisting the patient in obtaining needed dental services, including routine dental services. The facility will provide or obtain from an outside resource routine and emergency dental services to meet the needs of each patient Skilled Nursing Facilities must provide or obtain from an outside resource .routine and 24-hour emergency dental care/services to meet the needs of each resident Must if necessary, or if requested, assist the resident: In making appointments; Procedure: 2. Arrangements will be made promptly for routine and emergency dental services . Review of facility licensed Social Services Director Job Description, revised 12/06/16 provided by the DON, documented Purpose of your Job Position: Position Summary The Social Services Director plans, organizes, develops and directs the overall operation of the Social Services Department to ensure all medically-related emotional and social needs of patients are met in accordance with all applicable laws, regulations and Life Care standards .Involved with patients, associates, visitors, governmental agencies/personnel, etc. under all conditions and circumstances. Essential Functions: Must be able to implement a social services program that meets the medically-related social and emotional needs of patients as well as State, Federal, Corporate, and Division guidelines Must be able to concentrate and use reasoning skills and good judgment . Record review revealed Resident #48 was originally admitted to the facility on [DATE] and re-admitted to the facility on [DATE] with diagnoses which included Toxic Encephalopathy, Wedge Compression Fracture of Thoracic Vertebra, Malignant Neoplasm of Breast Anxiety Disorder, Gastroesophageal Reflux, Coronary Atherosclerosis, Chronic Obstructive Pulmonary Disease and Shortness of Breath. She had a Brief Interview Mental Status (BIM) score of 15 (cognitively intact). During an observational screening tour conducted on 01/24/23 at 10:15 AM, Resident #48 stated that about 10 years ago, she had a root canal done on her top, back, upper right tooth, located just in front of her wisdom tooth. However, Resident #48 went on to say that just before November 2022 of last year, she believes that a portion of the cap/crown put on the tooth just in front of where the root canal had been done, came off. The resident stated that ever since that time, she has been unable to chew on the upper right side of her mouth and her pain level for that tooth has been 3-4/10. She reported this to the Director of Social Services, who told her that she was placed on the list to be seen by the dentist. However, Resident #48 said she had not been seen by the dentist since August of last year and she doesn't understand why. An interview was conducted with the Director of Social Services Staff on 01/26/23 at 10:44 AM, regarding Resident #48's dental services. She stated that the facility's dental provider visits the facility to see the residents on a monthly basis. The Social Services Director stated that the following services are provided under Resident #48's Medicaid plan: semi-annual Hygienist assessments, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 18 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few semi-annual Dentist examinations, Oral Cancer Screening, Emergency visits, cleanings 6x/year, Denture cleaning six times per year, Fluoride Treatments, X-rays, Fillings, Denture/partials and extractions; some of these services are performed at the bedside depending upon the severity. When asked about the date of Resident #48's last dental visit in the facility, the Social Services Director indicated that it was on August 25th of 2022. She also indicated that she sent an e-mail to the dental services provider on 12/15/22, per Resident #48's request. However, the Social Services Director acknowledged that she did not report this request to Resident #48's nurse, nor did she follow-up with the dental office to ensure that the resident received the appropriate care and services in a timely manner, subsequent to that date. Record review of Resident #48's eligibility verification request documentation revealed that Resident #48 was eligible/approved for Full-Medicaid insurance coverage effective ever since 07/01/22. A side-by-side record review was conducted with the Social Services Director of the August 25th 2022 Oral Assessment in which it was noted that .recession on upper right area, patient stated that she has some sensitivity when eating . This dental note also included a sentence indicating the following .This oral assessment does not replace a Comprehensive Examination by a licensed Dentist. It is advised that this resident establish an ongoing relationship with a Licensed Dental Provider. Record review revealed that the Social Services Director sent an e-mail on 12/15/22 to the Dental Provider Team to include an attached resident face sheet along with a resident referral request for an assessment. Further record review indicated the Social Services Director documented in the computerized progress notes that [Resident #48] requested to be seen by dental services . On 12/06/22, the General Pain Care Plan documented that Resident expresses pain/discomfort. Interventions include: Anticipate the resident's need for pain relief and respond immediately to any complaint of pain Observe and report to Nurse resident complaints of pain (Photographic evidence was obtained.) On 01/27/23 at 12:20 PM, the Dental Provider Team, to include the Dentist, visited the facility to meet with the resident for an examination and x-ray. It was revealed/concluded/determined that Resident #48 was actually found to have a large, deep crack/cavity located in the tooth just in front of where the root canal had been done, on the resident's upper back, the right top side of her mouth. Resident #48 thanked this surveyor for her assistance in expediting the dental follow-up. The DON further acknowledged and recognized that dental care and services were to be provided to the resident during her facility stay, in a timely manner; this was not done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 19 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 - Some 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. Based on observation, interview, and record review, it was determined that the facility failed to follow the approved resident menu for physician ordered Pureed Diet, Mechanical Soft Diet, and Easy to Chew Diet for 31 residents that included 8 of 8 sampled residents (Resident #96, #83, #11, #42, #37, #60, #58 and #35). The findings included: 1) During the review of the approved menu for the lunch meal of 01/24/23, it was noted that a 2-ounce serving of Pureed Bread was to be served to residents receiving special diets, including (1) Pureed Diet, and (2) Mechanically Altered Diet. During the observation of the lunch meal in the main kitchen on 01/24/23 at 11:30 AM, it was noted that the tray line steam table did not contain prepared servings of Pureed bread. Interview with the Dietary Manager (DM) at the time of the observations noted that the Pureed Bread were not prepared as per the approved menu. It was further noted that the approved menu was not reviewed prior to the preparation of the lunch meal to ensure that all foods on the menu were prepared for the 01/24/23 lunch meal. 2) During the review of the approved menu for the breakfast meal of 01/25/23, it was noted that a 2-ounce serving of Pureed Muffin was to be served to residents receiving special diets, including (1) Pureed Diet, and (2) Mechanically Altered Diet. During the observation of the breakfast meal in the main kitchen on 01/25/23 at 7:30 AM, it was noted that the tray line steam table did not contain prepared servings of the Pureed Muffin. Interview with the Dietary Manager (DM) at the time of the observations noted that the Pureed Muffin were not prepared as per the approved menu and pureed bread was prepared with breadcrumbs and water. It was further noted that the approved menu was not reviewed prior to the preparation of the lunch meal to ensure that all foods on the menu were prepared for the 01/26/23 lunch meal. 3) During the review of the approved menu for the lunch meal of 01/26/23, it was noted that a 4-ounce serving of ground Stuffed Peppers was to be served to residents receiving special diets, including (1) Easy to Chew Diet, and (2) Mechanically Altered Diet. During the observation of the lunch meal in the main kitchen on 01/26/23 at 11:30 AM, it was noted that the tray line steam table did not contain prepared servings of Ground Stuffed Peppers. Interview with the Dietary Manager (DM) at the time of the observations noted that the ground Stuffed Peppers were not prepared as per the approved menu. It was further noted that the approved menu was not reviewed prior to the preparation of the lunch meal to ensure that all foods on the menu were prepared for the 01/26/23 lunch meal. 4) A review of the facility's Diet Census for 01/24/23 noted the following; * Physician Ordered Pureed Diet = 15 facility residents, which included sampled Resident #11, #37, #42, #83, and #96 * Physician Ordered Easy To Chew Diet = 8 facility residents, which included sampled Resident #60, and #58 * Physician Ordered Mechanically Altered Diet = 8 facility residents, which included Resident #35 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 20 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 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, prepare, serve, and distribute food in accordance with professional standards for food safety that include: ensure that the dish machine is sanitizing as per regulation, maintenance of ceiling panels to ensure food borne illness does not occur, cleaning of dish room walls to prevent mold growth, on-going preventive maintenance on refrigeration units, and ensure that food storage containers are being cleaned on a regular basis. The findings included: During the initial kitchen/food service observation tour conducted on 01/24/23 at 9 AM and accompanied with the Dietary Manager (DM), the following were noted: (a) Observation of the dish room noted that the dish machine was in use by facility staff. Interview with the DM at the time of the observation noted that the dish machine sanitizes resident dishware by the use of hot water (Final Rinse Minimum 180 degrees F (Fahrenheit) by regulation. Observation of the dish machine noted that the temperature gauges were broken and non-operational. The DM stated that the machine is tested to be sanitizing by regulation by the use of a food thermometer being put through the wash/rinse cycle. At the surveyors request the food thermometer was put through the dish machine for testing of the final rinse hot water temperature cycle. Three attempts were made by the DM and each test reached a maximum temperature of 152 degrees F. The surveyor informed the DM that the dish machine was note sanitizing at the minimum required regulatory temperature 180 degrees F and staff must cease utilizing the dish machine for dish washing until a final rinse temperature of 180 degrees F was obtained. The DM stated that the service company must be called for repairs and that disposable dishware would be utilized for the resident's lunch and dinner meal on 01/24/23. On 01/25/23 at 7 AM the DM submitted a invoice that the dish machine company was required to replace both of the thermometer gauges and replace the machine's heating element. The invoice also documented that the final rinse temperature was working properly upon departure. At the request of the surveyor the dish machine was tested by the DM and it was noted that after 3 tests the final rinse was recorded at 180-190 degrees F. The surveyor informed the DM that the machine was properly sanitizing and could now be used for dish washing. (b) Observation of the kitchen ceiling noted that numerous tiles located over food preparation areas (2), food serving areas (1) , and food storage area (1) were covered with area of dried food matter, dust/dirt, and brown stains. It was estimated that approximately 20 ceiling tiles required replacement. (c) During the tour it was noted that 2 soiled jackets were hung on food storage shelves and were coming into direct contact with foods being stored on the shelves that included containers of thickened milk and juices. The surveyor informed the DM that the jackets were soiled and are potentially contaminating the milk and juice containers. (d) Observation of the door gaskets of the walk-in refrigerator noted that there were 2-large tears (3-4 inches) in the plastic gasket. The surveyor requested that the gasket be replaced to ensure that the temperature of the unit remain at 41 degrees F or below. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 21 of 22 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center at Inverrary 4300 Rock Island Road Lauderhill, FL 33319 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 (e) Observation of the exterior surfaces of the walk-in refrigerator and freezer was noted to be rust laden. The surveyor discussed with the DM that repairs are required to the exterior to prevent potential food borne illness. (f) The exterior covers of the sugar and flour ingredient bins were noted to be heavily soiled with dirt and dried food matter. The surveyor discussed with the DM that each time the bins are opened there is the potential for food contamination from the dirt and dried food matter falling into the ingredient bins. (g) Observation of the convection oven noted that the exterior bottom had a heavy buildup of dried food matter. The surveyor discussed with the DM that the oven was not being cleaned on a regular scheduled basis. (h) During the observation of the dish machine room it was noted that the wall next to the clean dish run was covered with a large area of black type mold matter. The surveyor requested that the area be cleaned and sanitized prior to continued use of the dish machine . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 22 of 22