Inspection·August 14, 2025

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to follow physician orders for oxygen therapy care and management for 2 of 4 sampled residents (Resident #23 and Resident #40), and failed to follow its own policy to ensure the respiratory care and services are in accordance with professional standards of practice by: failing to properly disinfect and store nebulizing masks for 2 of 4 sampled residents (Resident #45 and Resident #100); failed to have an order for a required tracheostomy tube size, and failed to maintain sterility during tracheostomy care for 1 of 2 sampled residents (Resident #1). The facility also failed to provide a readily available tracheostomy inner canula for immediate care for 2 of 2 observations and for 1 out of 2 sampled residents reviewed for tracheostomy care (Resident #9). The findings included:Review of facility's policy titled, Oxygen Administration (Infection Control, Safety, & Storage, undated, revealed the following: Oxygen should be written for specific liter flow required by the resident. Change oxygen supplies (e.g. cannula, tubing, humidifier) weekly, and when visibly soiled. Equipment should be labeled with resident name and dated when set up or changed out. Review of the facility's Tracheostomy Care Policy, with the latest review date of [DATE], revealed the following: The facility will provide and perform tracheostomy care in accordance with physician orders and current standards of care.Use sterile cotton tipped applicator and a sterile gauze pad to clean the stoma site. A review of the facility's policy titled, Tracheostomy tube cannula and stoma care, undated, revealed the following: If a product is expired, is defective, or has compromised integrity, remove it from patient use. Make sure that extra tracheostomy tubes and obturator, as well as the handheld resuscitation bag with an attached oxygen source are readily available for easy access in case of an emergency. Open the tracheostomy care kit using sterile technique.Using sterile technique, pour sterile normal saline solution, sterile water or other cleaning solution, into one of the sterile solution containers. Record review revealed Resident #23 was admitted on [DATE] with diagnoses that included Fracture of Nasal Bones, Fracture of the Orbital Floor, Gastroesophageal Reflux Disease without Esophagitis and Hyperlipidemia. A review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] under Section C of the Brief Interview for Mental Status (BIMS), revealed a score of 5 indicating Resident #23 had severe cognitive impairment. Section O, subcategory, C1. under oxygen therapy revealed a no' response, indicating Resident #23 was not receiving oxygen therapy. An electronic record review of physician orders dated [DATE] revealed the following: Oxygen at 2 liters per minute continuously per nasal cannula, document every shift.Change oxygen tubing and nebulizer circuit, every night shift, every Sunday, label when changed. Oxygen saturation rates, every shift. A review of the Medication Administration Record (MAR) for [DATE], revealed oxygen at 2 Liters per minute, continuously, per nasal cannula, to document every shift. These orders were carried out as indicated by check marks, and Nurses' initials during AM and PM shifts, on the dated columns. During an observation conducted on [DATE] at approximately 11:26 AM, the oxygen calibration ball observed on the oxygen concentrator cylinder, was level at 3.5 Liters per minute, indicating the physician order was not followed. During another observation conducted on [DATE] at 11:02 AM, the oxygen calibration ball was at 2.5 liters per minute level, indicating the physician order was not followed. In an interview conducted with Staff D, Licensed Practical Nurse (LPN) on [DATE] at 10:34 AM, when she was asked regarding oxygen therapy, she stated the doctor's orders must be followed. 2) Record review revealed Resident #40 was admitted to the facility on [DATE] with diagnoses that included Chronic Obstructive Pulmonary Disease, Muscle Weakness, and Anxiety. A review of the annual Minimum Data Set (MDS) assessment, dated [DATE] under Section C of the Brief Interview for Mental Status (BIMS), revealed a Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 2 of 16 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 08/14/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few score of 13, indicating Resident #40 was cognitively intact. A review of physician orders dated [DATE] revealed oxygen at 2 liters per minute per nasal cannula as needed, for shortness of breath (SOB). An additional review of a physician order dated [DATE], revealed to change oxygen tubing, and nebulizer circuit every night shift, and every Sunday. Review of the [DATE] Treatment Administration Record (TAR) revealed that the oxygen tubing and the nebulizer circuit were changed on the night shift hours on [DATE] and [DATE], as indicated by check marks and Nurse's numbers and initials. During an observation conducted on [DATE] at 10:51 AM, the oxygen tubing connected to the oxygen concentrator for Resident #40, was marked with black ink revealing the date of [DATE] on a white sticker wrapped around the tubing, indicating the doctor's order was not carried out. Additional observations revealed the presence of a clear tubing contained inside a plastic bag with a blue sticker label wrapped around it, but with nothing written on it. The bag where the tubing and mask were contained had no visible dated tag. In an interview conducted with Staff G, Unit Manager on [DATE] at 9:57 AM, when she was asked how often the oxygen tubing and the nebulizing tubing are changed, she responded, Weekly, and as needed, such as when soiled. The facility staff would wrap a sticker around the oxygen and nebulizing tubing. The sticker would include the date, resident's room, number and resident's name. When asked if staff document when the oxygen and nebulizing tubing and supplies were changed, she responded, Yes, in Medication Administration Record (MAR). 3) Record review revealed Resident # 100 was admitted to the facility on [DATE] with diagnoses that included Atrial Fibrillation, Primary Hypertension, Atherosclerotic Heart Disease, Vascular Dementia and Chronic Obstructive Pulmonary Disease with Acute Exacerbation. A review of the quarterly Minimum Data Set (MDS) assessment, dated [DATE], under Section C of the Brief Interview for Mental Status (BIMS), revealed a score of 07, indicating Resident # 100 had severe cognitive impairment. Section O dated [DATE], revealed a yes response to oxygen therapy. An electronic review of a physician order dated [DATE], revealed Ipratropium-Albuterol Inhalation Solution 0.5-2.5, 3 milligrams (mg) per 3 milliliters (ml),1 application inhale orally, two times a day for wheezing. In an interview conducted with Staff D, LPN, on [DATE] at 10:34 AM, when she was asked regarding nebulizing therapy care and management, she stated the doctor's orders are followed. When she was asked how the facility staff disinfect the nebulizing mask, and tubing after resident's usage, she responded, I clean them with warm tap water, I use no soap and leave them to air dry. I usually place a paper towel under them after rinsing, to let them dry. I use warm water from the tap. I usually clean them inside the residents' bathroom. During an observation conducted on [DATE] at 5:13 PM, on top of Resident #100's bathroom sink, a nebulizing face mask and its parts were present. When Staff N, Registered Nurse (RN) was asked why they were on the bathroom sink, she responded that the AM shift nurse did not store it properly after administering the morning nebulizing treatment. When she was asked how they clean the nebulizing face mask and its parts after residents' usage, she responded, We rinse them with tap water and let them air dry. When asked how long it would usually take to air dry the nebulizing mask and its parts, she responded, Not long, probably 20 minutes. The morning shift nurse must have forgotten them in the resident's bathroom. When she was asked when was the last the treatment provided for this resident, she responded, 'Probably at around 9:00 AM. She added that she would provide another nebulizing treatment for this resident at 6:00 PM. When she was asked how they store the nebulizing treatment face mask and other nebulizing supplies, she responded, We usually bag, label, and put them inside the resident's drawer. In an interview conducted with Staff K, LPN, on [DATE] at 4:29 PM, when she was asked regarding nebulizing supplies and face mask care after treatment, she responded, I wash the tubing and mask with soap and water. 4) Record review revealed Resident #45 was admitted to the facility on [DATE] with diagnoses that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 3 of 16 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 08/14/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few included Vascular Dementia, Dysphagia, Shortness of Breath, Cachexia, Depression, Parkinson's Disease without Dyskinesia, Cerebral Atherosclerosis, and Bronchitis. A review of the quarterly Minimum Data Set (MDS) assessment, dated [DATE] under Section C, revealed a Brief Interview for Mental Status (BIMS) score of 4, indicating Resident #45 had severely impaired cognition. An electronic record review of a physician order dated [DATE], revealed Ipratropium-Albuterol Solution 0.5-2.5, 3 milligrams (MG) per 3 milliliters (ml), inhale orally via nebulizer, every 6 hours for shortness of breath (SOB). A review of [DATE] MAR revealed the above physician order was carried out as indicated by check marks, and Nurses' initials on the indicated times and dates. During an observation and interview conducted on [DATE] at approximately 2:44 PM, after Resident #45 received a nebulizing treatment from Staff P, LPN, who was asked how she disinfects the nebulizing face mask and its parts after use, responded that she disconnects the removable parts and rinses these different parts and the face mask with tap water inside the resident's bathroom. She was observed rinsing the nebulizing face mask and its 2 removable plastic parts under the sink faucet with running water on [DATE] at 12:47 PM. She then dried them with a paper towel and placed all parts on top of a paper towel onto the bathroom sink. When she was asked if that is the facility recommended disinfection process for the nebulizing face mask and its parts, she responded, That is how we do it. When she was asked how long she would leave the mask and its parts onto the bathroom sink, she responded, About 5 minutes, maximum. I would then place them in a plastic bag. The bag is placed inside the resident's bedside drawer. She was observed performing this task on [DATE] at approximately 12:52 PM. 5) Record review revealed Resident #1 was admitted to the facility on [DATE] with diagnoses that included Unspecified Quadriplegia, Cerebrovascular Accident and Encounter for Surgical After Care following Surgery of the Respiratory System, and Digestive System. On [DATE], a recent Minimum Data Set (MDS) assessment was performed due to a significant change in the resident's condition. Section C of the Brief Interview for Mental Status (BIMS) revealed a score of 13, indicating Resident #1 had no cognitive impairment. Section O revealed a yes response to tracheostomy. A review of an order dated [DATE], revealed tracheostomy at the bedside, but it did not include a specific tracheostomy size. On [DATE], another physician order revealed to change the tracheostomy dressing every 8 hours as needed, and every night shift. During morning observations conducted on [DATE] and on [DATE], there were boxes of Shiley cannula located on top of a dresser at the foot part of resident's bed. One box had reference number 6CN75 H, and the other 2 boxes had the same reference number of 4UN65H. During a tracheostomy care and suctioning observation on [DATE] at 2:35 PM with Staff E, LPN, she stated the tracheostomy care kit she would be using expires in 2028. When she was asked to show this surveyor the expiration date, she responded that she saw the expiration date on the box where she removed the tracheostomy care kit from. Staff E had all the supplies assembled on top of the resident's meal table. She performed hand washing and stated she would start the tracheostomy care and suctioning. She asked another staff member to measure the oxygen saturation and oxygenate the resident. Staff E opened the flap outward of tracheostomy care kit and picked up a sterile glove from it. She did not step backward but kept her unsterile left hand on top of the kit while gloving her right hand. When her right hand was gloved, she tried putting the left glove but contaminated it by touching the skin on her wrist with the right-hand fingers. She continued even after she was informed that she contaminated her gloves. She removed the dressing around the stoma site and disconnected the tie. Another staff member helped her with the tracheostomy tie. Staff E discarded her gloves and put on another set of sterile gloves but did not maintain sterility. With her gloves on, she picked up a pad from the tracheostomy (trach) care kit, opened it, spread it on the left side of trach care kit. Staff picked up the trach care kit and placed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 4 of 16 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 08/14/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few it on top of the pad, with her left-hand glove touching the outer edges of the chucks, and her right hand touched the right side of the trach care tray kit and the middle part of the trach care kit on [DATE] 2:49 PM. She was asked why she did that, she did not respond first. Then, she stated to keep it sterile. She was informed that she got unsterile since her left glove touched the outer edges of the pads and her right gloved hand touched the right side and the top portion of the trach care kit. She continued and used her right hand to pick up gauze from the tracheostomy care kit. Then with her left hand she touched the same gauze. Fingers from both hands touched the same gauze. She wiped the area around tracheostomy stoma using the right hand. She did it 2 x with the same gloves. Staff E picked up an unsterile saline solution plastic bottle on top of other supplies at the right side of the resident's table, with her right gloved hand and opened the solution's top seal. Staff E used both gloved hands in opening the unsterile saline plastic container. Staff E poured the saline contents onto the tracheostomy care kit using the right gloved hand. She was asked if she applied sterile technique in opening the saline solution. She stated her gloves are still sterile on [DATE] 2:50 PM. She stated the saline solution had an expiration date of 08/27. On [DATE] at 3:10 PM during continued observation, Staff E, LPN opened the top flap of a suction catheter kit. She stated that it was a size Fr. 14 but with no expiration date. She stated she did not know the expiration date of the suction care kit, but she would use it because the resident needed suctioning. During a continued observation, Staff E, stated she would get another set of sterile gloves to use during tracheostomy suctioning. She was observed taking a package of gloves from a plastic Ziploc bag. The glove package had written notes on it stating, Open outside sterile field. When Staff E, LPN was asked if she thought the gloves were sterile, she responded, Yes, they are inside a Ziploc bag. During an observation and interview with the Director of Nursing on [DATE] at approximately 4:04 PM, she was holding a box of the tracheostomy care kit and showing it to this surveyor. She stated that the tracheostomy care kit had no expiration date. She further stated that the tracheostomy care kit used for Resident #1 came from this box with no expiration date. An interview was conducted with the Registered Nurse Educator on [DATE] at approximately 10:00 AM, who stated she started just a few months ago. She added that she would hold an RN skills fair in December, and she would educate Nurses regarding tracheostomy care. She added that she provided in-services before, but she would do more reviews for tracheostomy care. In an interview conducted on [DATE] at approximately 10:42 AM with Staff D, LPN, who was asked about the tracheostomy's inner cannula size of Resident #1. She responded that it is ordered by the central supply staff. She stated there is no documented physician order for the tracheostomy's inner cannula and the actual tracheostomy size for this resident. She added that the central supply staff knows the size of the tracheostomy tube and inner cannula. 6) Record review revealed Resident #9 was admitted on [DATE] with diagnoses that included Acute Pulmonary Edema, Chronic Respiratory Failure, Chronic Diastolic Congestive Heart Failure, and Encounter for Tracheostomy. A review of the recent Minimum Data Set (MDS) assessment dated [DATE], revealed a blank space for the Brief Interview for Mental Status (BIMS), indicating it was not assessed. Section O revealed a yes response to tracheostomy care. An electronic review of orders dated [DATE], revealed to change the tracheostomy inner cannula weekly and as needed, every night shift, every Saturday, and use sterile gloves only; may change every 8 hours as needed for airway clearance; use sterile gloves only. A review of another order on the same date revealed tracheostomy to size 6 cuffless daily, in the morning. A further review of Medication Administration Record (MAR) and Treatment Administration Record (TAR) for [DATE], revealed a physician order to change the tracheostomy inner cannula every night shift, and weekly, were carried out as indicated by check marks, and Nurses' initials on [DATE] and [DATE]. During an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 5 of 16 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 08/14/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete observation conducted on [DATE] at 12:12 PM, there was a Shiley disposable inner cannula box in the room on top of a dresser, but when it was opened, it revealed the box was empty. The Private Aide was asked if there were any more inner cannula boxes in the room. The Private Aide checked the drawers but stated she could not locate any tracheostomy inner cannula boxes. During another interview with Resident #9's Private Aide on [DATE] at approximately 12:49 PM, when asked if facility staff member brought another tracheostomy inner cannula box, she responded, No. She added that yesterday, a staff member took the empty box but did not replace it. She added that she has been watching and waiting for a facility staff to come back with a new box, but no staff member did. When she was asked where the tracheostomy inner cannula box is located daily, she responded, inside the drawer or on top of the drawer, on the foot part of Resident #9's bed. There was no inner cannula box on top of the drawer, and inside the drawer upon inspection by this Private Aide. When she was asked to check the contents of all the drawers, and other areas where the tracheostomy inner cannula box might be, she stated that there was no tracheostomy inner cannula box found inside Resident #9's room. In an interview conducted on [DATE] at 10:34 AM with Staff D, LPN, who was asked about the tracheostomy's inner cannula size for Resident #9, responded that she had never changed the cannula, and she does not know the size. She added that only the central supply person knows the size of resident's tracheostomy tube and inner cannula. When she was asked how often she would normally check if an inner cannula was present inside the room of a resident with a tracheostomy, she responded, Once a day, and I make sure there was more than one box inside the room. Event ID: Facility ID: 106047 If continuation sheet Page 6 of 16 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 08/14/2025 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to follow the professional standards of practice and doctor's order regarding taking blood pressure (BP) on the dialysis access site for 1 of 1 sampled resident (Resident #5) reviewed for dialysis. The findings included:Record review revealed Resident #5 was admitted to the facility on [DATE] with diagnoses that included End Stage Renal Disease, Acute Post Hemorrhagic Anemia, and Respiratory Tuberculosis. A review of the most recent Minimum Data Set (MDS) assessment, dated 06/08/25, under Section C of the Brief Interview of Mental Status (BIMS) revealed a score of 13 indicating Resident #5 had intact cognition. A review of physician orders dated 06/12/25, documented to not take BP on right arm with fistula/shunt. A further review of BP documentation on Point Click Care (PCC- electronic health record for Nursing Homes), revealed that Resident #5's BP measurements were taken on the right arm during the following dates and times: On 05/14/25 at 10:05 [NAME] 05/16/25 at 10:11 PMOn 06/07/25 at 11:01 [NAME] 06/07/25 at 11:02 PMOn 06/08/25 at 10:21 PMOn 06/11/25 at 9:12 [NAME] 06/12/25 at 9:13 [NAME] 06/25/25 at 11:30 AM On 06/30/25 at 10:10 AM On 07/05/25 at 10:35 PMOn 07/06/25 at 10:20 PMOn 07/19/25 at 9:37 PMOn 07/20/25 at 10:02 PMOn 07/21/25 at 10:13 AM On 07/25/25 at 10:01 PMOn 07/29/25 at 10:34 [NAME] 08/02/25 at 9:31 PM On 08/06/25 at 10:03 AM In an interview conducted with Resident #5 on 08/12/25 at 12:45 PM, he stated that sometimes, facility staff takes his BP on the arm of the dialysis site. In an interview conducted with Staff N, Registered Nurse (RN) on 08/13/25 at 4:36 PM, when she was asked about nursing care of a resident on dialysis, she responded to check for bruit and pulses on the dialysis access site but take the BP on the opposite arm because Staff must not use the dialysis site arm. Staff document in PCC what arm was used during BP monitoring. She added that Nurses document l for left arm and r for right arm, whether the resident was lying or sitting and the time the BP was taken Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 7 of 16 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 08/14/2025 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure a resident's medication regimen for psychotropic (antipsychotic) medication was monitored appropriately, as evidenced of the lack of written documentation of behavior monitoring for 1 of 5 sampled (Resident #3) residents reviewed for Unnecessary medications. The findings included:Review of the facility policy provided by the Assistant Director of Nursing titled Psychotropic Medication Use revised on 09/15/24 documents .psychotropics medications are drugs that affect .behavior and include .antipsychotics.facility staff should monitor the resident's behavior pursuant to facility policy using behavioral monitoring chart.for residents receiving psychotropic medication.facility staff should monitor behavioral triggers, episodes and symptoms.Review of Resident #3's clinical record documents an admission to the facility on [DATE] with a readmission on [DATE]. Resident #3's diagnoses included Anoxic Brain, Cognitive Communication Deficit, Bipolar Disorder, and Seizures.Review of Resident #3's record documents an active physician order dated 07/03/25 for Seroquel Oral Tablet 25 milligrams (mg), give 12.5 mg by mouth two times a day for Bipolar Disorder; Seroquel Oral Tablet 25 MG give 1 tablet by mouth at bedtime for Bipolar Disorder dated 07/02/25 and discontinued on 07/22/25. Seroquel Oral Tablet 25 MG give 1.5 tablet by mouth at bedtime for Bipolar Disorder dated 07/22/25.Review of Resident #3's July and August 2025 Medication Administration Record (MAR) and Treatment Administration Record (TAR) revealed a lack of written documentation of behavior monitored for the resident's Seroquel, an antipsychotic medication. Review of Resident #3's Minimum Data Set (MDS) admission assessment dated [DATE] documents a Brief Interview Mental Status (BIMS) score of 3 indicating severe cognition impairment. The assessment documents the resident received antipsychotic medication seven (7) days prior of the completion of the assessment. On 08/13/25 at 11:45 AM, a side-by-side review of Resident #3's July and August 2025 MAR and TAR was conducted with the Assistant Director of Nursing (ADON) who stated the resident went out to the hospital and the Seroquel behavior monitoring was not reimplemented. The ADON confirmed Resident #3 clinical record did not contain documentation of behavior monitoring related to Seroquel.On 08/14/25 at 3:30 PM, an interview was conducted with Staff K, Licensed Practical Nurse (LPN) who stated if they have a resident on Seroquel they have to complete behavior monitoring, and it is documented on the resident's MAR or TAR.On 08/14/25 at 3:33 PM, an interview was conducted with Staff N, Registered Nurse (RN) who stated if they have a resident on Seroquel they do monitor side effects and behavior, and it is documented on the TAR. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 8 of 16 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 08/14/2025 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide double portions for 2 of 2 sampled residents (Resident #6 and #107) reviewed for dining observations, and for 1 of 1 tray line observations in the kitchen. This has the potential to affect 8 residents with double portions orders. The facility failed to provide fortified foods during observations in the kitchen, that has the potential to affect 12 residents who are to be served fortified foods. The findings include: 1. During an observation conducted in the main kitchen on 08/13/2025 at 12:00 PM, on three occasions, a Dietary Aid was seen reading the double portion meal ticket to the Cook, Staff A. During the observations, Staff S did not understand what double portion meant. This surveyor had to intervene, as the plate was already placed on the tray with single portions and ready to go on the cart. At the time of intervention, the CDM (Certified Dietary Manager) had to explain to Staff A that double portion meant two scoops of each food item to be served. 2. During an observation conducted in the main kitchen on 08/13/2025 at 12:10 PM with most of the trays in the carts ready to go on the floor, this surveyor asked the Certified Dietary Director to identify the fortified mashed potatoes and that's when they realized that no fortified mashed potato servings were cooked today. At that moment, the Certified Dietary Director then asked a dietary aid to make the fortified mashed potatoes. In an interview conducted on 08/13/2025 at 4:05 PM, the Certified Dietary Director stated that she didn't have an explanation for the cook not understanding the definition of double portions. She further stated that regarding fortified foods, she always identifies the fortified food when she is taking the temperatures, but because she didn't take the temperature today, she did not realize that it wasn't on the tray line. In an interview conducted on 08/13/2025 at 2:20 PM, the Registered Dietitian (RD) stated that she has been working in this facility for 5 years and comes to the facility twice a week (Tuesday and Thursday). She explained that it's very important for a resident to receive fortified food because it's a nutritional intervention. She also explained that the kitchen follows a recipe from corporate for fortified foods. For example, for breakfast they add butter and sugar to the oatmeal which makes it fortified; for lunch they add milk and creamer to the mashed potatoes. RD stated that oatmeal and mashed potatoes are the only fortified foods they offer. Regarding the double portions, the RD stated that a plate with double portions should have double entrée: double protein, double carbohydrates and double Vegetable. For example, the lunch for today should have two slices of meatloaf, two scoops of mashed potato, two scoops of spinach and the dessert and the drink should be one. The RD acknowledges that for a double protein a cheeseburger should have 2 patties. In an interview conducted on 08/14/2025 at 11:00 AM, with the Cook, Staff A, she stated that she has been working in this facility for 5-6 months and she is being trained in the kitchen by the manager. Regarding the double portions, Staff A explained that before the incident, she was under the impression that double portion meant double protein. 3. On 08/11/25 at 12:17 PM, during dining observations at the facility's [NAME] 1 unit, Resident #107 was observed sitting in the dining room and had main dish portions on a small scoop plate. The resident meal ticket documented “Double Portions…scoop plate”. Further observation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 9 of 16 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 08/14/2025 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 revealed the plate had one scoop of mashed potatoes, vegetables and meat. The portions were not double as per the meal ticket. On 08/13/25 at 12:20 PM, observation revealed Staff I, Certified Nursing Assistant (CNA) feeding Resident #107. Subsequently, an interview was conducted with Staff I who was asked if Resident #107 had double portions on her plate. Staff I was not able to state if the resident had double portion meal. Resident #107 meal portions were not double. On 08/13/25 at 2:16 PM, a joint interview with the facility Consultant Registered Dietitian (RD) and the survey team were conducted. The RD stated a resident with a double portions order should have double protein, carbohydrate and double vegetables. The RD stated a resident with a scoop plate should have two plates to accommodate double portions and added she believed they did not have any residents on a scoop plate. On 08/14/25 at 11:24 AM, an interview was conducted with the Assistant Director of Nursing (ADON) who stated she had a resident who the family asked for double food portions but was discontinued because of a weight gain. She stated she did not have any resident on double food portions. The ADON was asked who checks the resident's tray to ensure they receive the correct meal and replied that the CNA, the nurses, and herself will check the meal tray to make sure they get the right tray: staff are supposed to know what the resident is to get on the tray. The ADON stated Resident #107 was a set-up before for meals but needs to be fed now. On 08/14/25 at 12:05 PM, an interview was conducted with Staff O, CNA who stated that for a double portion meal, the resident will have two scoops of the food. Staff O was apprised Resident #107 did not receive two scoops of the food on 08/11/25 and on 08/13/25. On 08/14/25 at 12:01 PM, during an interview, the ADON was asked how she can tell if the resident who has a fortified food diet is receiving it as ordered and replied that a resident on a fortified food diet gets a magic cup. On 08/14/25 at 12:07 PM, an interview was conducted with Staff O, CNA who was asked what fortified food is and stated a magic cup and for breakfast they get prepared oatmeal. On 08/14/25 at 12:10 PM, an interview was conducted with Staff K, LPN who was asked what fortified food is and stated the resident on fortified food will get a magic cup. 4. Record review revealed Resident #6 was admitted to the facility on [DATE] with diagnoses that included Malignant Neoplasm of Temporal Lobe, Malignant Neoplasm of Parietal Lobe, and Enterocolitis due to Clostridium Difficile, (C. Diff). (C. Diff is a serious bacterial infection that primarily affects the colon, often causing severe diarrhea and inflammation). His brief interview for Mental Status (BIMS) score was 11 on the admission Minimum Data Set (MDS) assessment dated [DATE]. This indicated the resident had mild cognitive impairment. Record review revealed on 07/01/2025, the resident weighed 174.4 pounds. On 08/11/2025, the resident weighed 154.6 pounds, which is a -11.35% loss. On 07/22/25 the Dietician recommended double portions for weight loss for Resident #6. An observation of lunch was conducted on 08/13/25 at 12;30 PM. The resident's meal ticket (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 10 of 16 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 08/14/2025 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 documented “Double Portion”. Further observations revealed lunch was delivered with a magic cup, apple juice, 1 meatloaf slice, 2 servings of mashed potatoes, a scoop of spinach and one piece of pie. On 08/13/25 at 2:16 PM, a joint interview with the facility's consultant Registered Dietitian (RD) and the survey team surveyors were conducted. The RD stated a resident with a double portion order should have double protein, carbohydrate and double vegetables. A double portion for Resident #6 for lunch on 08/13/25 should have been 2 slices of meatloaf, 2 scoops of mashed potatoes, 2 scoops of spinach and 1 piece of pie. An interview was conducted on 08/13/25 at 3:56 PM with the Dietary Director. She stated Resident # 6 should have received 2 slices of meatloaf for lunch for double portions. An interview was conducted with Resident #6 on 08/14/25 at 8:50 AM. Resident #6 was asked if he ate breakfast today and he stated he did, and it was pancakes. The resident did not receive the fortified oatmeal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 11 of 16 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 08/14/2025 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide the correct diet consistency for pureed diets, for 5 of 5 sampled residents (Resident #20, Resident #45, Resident #108, Resident #33 and Resident #15) observed on pureed diets. This has the potential to affect 10 residents receiving pureed diets. The findings include: 1. Record review revealed Resident #20 was admitted to the facility on [DATE] with diagnoses of Degenerative Disease of Nervous System and Encounter for palliative care. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) revealed that Resident #20 was unable to conduct the interview. A review of Resident #20's orders dated 06/19/25 documented the following: Regular diet, Puree texture, Nectar/Mildly consistency, nectar fluids by teaspoon. In an observation conducted on 08/11/25 at 1:15 PM revealed Resident #20's meal ticket diet consistency read puree regular and nectar fluid. Further observation revealed Resident #20's tray consisted of a lumpy beige pureed food, grainy light brown pureed food and a yellow and brown pureed food with a red sauce. 2. Record review revealed Resident #45 was admitted to the facility on [DATE] with diagnosis of Parkinson's Disease without Dyskinesia and Bronchitis. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the resident's Brief Interview of Mental Status (BIMS) score was 4, which indicates severe cognitive impairment. A review of orders dated 07/21/25 indicated the following: Regular diet, Puree texture, Honey/Moderately consistency, Fortified Foods with all Meals. In an observation conducted on 08/11/25 at 1:30 PM, observation revealed Resident #45's meal ticket diet included consistency as puree, regular, honey/moderately consistency. Resident #45's tray consisted of a lumpy beige pureed food, a grainy light brown pureed food and a yellow and brown pureed food with a red sauce. In an observation conducted on 08/12/25 at 12:42 PM, observation revealed Resident #45's meal ticket diet consistency is puree, regular, honey/moderately consistency. Further observations revealed Resident #45's meal tray consisted of grainy brown pureed-like food, and orange pureed-like food, a light yellow pureed-like scoop of food and a light brown topped with gravy pureed like food. 3. Record review revealed Resident #108 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnosis of Encephalopathy and Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris. The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the resident's Brief Interview of Mental Status (BIMS) score was 3, which indicates severe cognitive impairment. A review of the orders dated 07/22/25 revealed the following: Regular diet, Puree texture, Nectar/Mildly consistency. In an observation conducted on 08/11/2025 at 1:30 PM this surveyor observed that Resident #108 meal ticket diet consistency was puree, regular, double portions, nectar. Further observations revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 12 of 16 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 08/14/2025 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #108's tray consisted of a lumpy beige pureed food, a grainy light brown pureed food and a yellow and brown pureed food with a red sauce. In an interview conducted on 08/13/2025 at 2:20 PM, the Registered Dietitian (RD) stated that a pureed texture is not supposed to be runny nor too thick. Some food may be lumpy, grainy-like depending on the food like bread and pancake but mostly should be smooth. I don't check the tray line for the pureed food because I do more clinical work. She further explained that she hasn't checked the tray line this past week. The RD acknowledged the findings. In an interview conducted on 08/13/2025 at 4:10 PM, Certified Dietary Director stated that pureed food should look like an ice cream scoop but not exactly because it's too dry, so a semi melted ice cream. The Dietary Director acknowledged the findings and said she will find a solution to make sure the pureed foods are very smooth. In an interview conducted on 08/14/2025 at 11:00 AM with the cook, Staff A, she stated that she makes the pureed food in the food processor machine. For the bread you must leave it in the food processor machine a lot. Since I started working here, they always told me all pureed are in the food processor machine. In an interview conducted on 08/14/2025 at 11:30 AM, the Speech and Language Pathologist stated that she has been working for the facility for almost 6 years. She further explained that pureed food should be blended, not runny, cohesive, different than chopped, lumps would be fine like a tapioca pudding would be fine, not grainy with solid parts, mostly smooth, nothing that would need to be chewed. The Speech and Language Pathologist showed the pictures and said it was okay to be a little lumpy. 4. On 08/11/25 at 12:38 PM during dining observations at the facility's [NAME] 1 unit, Resident #33's meal ticket read Puree, Regular diet. Observation revealed the food texture was lumpy and not pureed as ordered. The resident was not interview able and was not able to feed herself. Resident #33's diagnoses included Unspecified Protein-Calorie malnutrition, Dysphagia-Oropharyngeal Phase, Unspecified Dementia, and Cognitive Communication Deficit. 5. On 08/11/25 at 12:40 PM, during dining observations at the facility's [NAME] 1 unit, Resident #15 meal ticket read/documents Puree, regular diet: observation revealed the food texture was lumpy and not puree as ordered. The resident was not unreviewable and was not able to feed herself. Resident #15 diagnoses included Dysphagia-Oropharyngeal Phase, Cognitive Communication Deficit and Alzheimer's. On 8/13/25 at 2:16 PM, a joint interview with the facility consultant RD and the survey team surveyors was conducted. The RD stated that for Puree texture food she makes sure is not running, not too thick, some food may be lumpy and should be smooth. During an interview, a side-by-side review of Resident #15's photographic evidence of puree food served on 08/11/25 was shown to the RD who confirmed the food was lumpy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 13 of 16 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 08/14/2025 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide food that meets residents' preferences, for 3 out of 22 sampled residents observed during dining. (Resident #21, Resident #55, Resident #62).The findings included:1. A record review showed that Resident #21 was admitted on [DATE] with diagnosis of unspecified fracture of right femur, subsequent encounter for closed fracture with routine healing and fracture of unspecified part of neck of right femur. The Quarterly Minimum Data Set (MDS) dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score is 14, which indicates no cognitive impairment.In an observation conducted on 08/11/2025 at 1:15 PM this surveyor observed that Resident #21 meal ticket consisted of Broccoli & Cauliflower under the Allergies and Dislikes section. Resident #21 tray consisted of a mix of vegetables including cauliflower and broccoli. Residents #21 ate everything on the plate except the mixed vegetables. Resident #21 stated that she is tired of explaining that she doesn't eat broccoli or cauliflower, but she always gets them on her tray.2. A record review showed that Resident #55 was admitted on [DATE] and readmitted on [DATE] with diagnosis of anemia and hereditary and idiopathic neuropathy. The Medicare -5 Day Minimum Data Set (MDS) dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score is 15, which indicates no cognitive impairment.In an observation conducted on 08/11/2025 at 1:18 PM, this surveyor observed that Resident #55 meal ticket consisted of Double Protein in Preferences and Resident #55 tray consisted of a single patty cheeseburger with lettuce and tomato.In an observation conducted on 08/12/2025 at 12:45PM, this surveyor observed that Resident #55 meal ticket consisted of Double Protein in Preferences and Resident #55 tray consisted of a single patty cheeseburger with lettuce and tomato.3. A record review showed that Resident #62 was admitted on [DATE] with diagnosis of cachexia and cognitive communication deficit. The Quarterly Minimum Data Set (MDS) dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score is 15, which indicates no cognitive impairment.In an interview conducted on 08/11/2025 at 12:36PM, Resident #62 stated that she did not order mashed potato with meat sauce but spaghetti with meat sauce. Resident #62 was very mad and further explained that it's not the first time. In an observation conducted on 08/11/2025 at 12:35 PM, this surveyor observed that Resident #62 tray consisted of mashed potato and meat sauce. Resident #63 showed this surveyor a sheet of paper where she writes what she wants to eat every day for lunch and dinner.In an interview conducted on 08/13/2025 at 2:20 PM, Registered Dietitian stated that a plate with double portions should have a double entree: double protein, double carbohydrate, double vegetable. Like lunch today should have been two slices of meatloaf, two scoops of mashed potato, two scoops of spinach and the dessert and the drink should only be one. RD acknowledged that for a cheeseburger they should have 2 patties.In an interview conducted on 08/13/2025 at 4:00 PM, Certified Dietary Director stated that she has been working for this facility for almost two years. She further explained that the person doing the tray is supposed to read the ticket to the cook. The only way I can make sure that the meal ticket matches the tray is by making sure that the meal ticket is as accurate as they can be. And it also starts with getting the information's from the patients. The Certified Dietary Director acknowledged the findings and admitted that she could of sent the alternative to Resident #21. Event ID: Facility ID: 106047 If continuation sheet Page 14 of 16 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 08/14/2025 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to follow their own policy for Clostridium Difficile Infection (CDI) regarding meal tray removal for 1 sampled resident (Resident #6) and failed to follow their policy for disinfection of machine and equipment after residents' use during 2 observations.The findings included:A record review of a policy titled, Clostridium Difficile (CDI) with the latest revision date of 02/22/21, it revealed meal trays should be bagged prior to removal from the room and are then placed on the tray cart (p.2, no.7).An additional record review of a policy titled, Cleaning and Disinfection of Non-Critical Patient Care Equipment, with the latest revision date of 08/22/22, revealed the following: Equipment will be cleaned and disinfected prior to storage (p. 2, no.1). Non-critical items require cleaning followed by either low or intermediate-level disinfection following manufacturers' instructions (Procedure no.1.) Disinfection should be performed with an Environmental Protection Agency (EPA)- registered disinfectant labeled for use in healthcare settings (Procedure no.2). A record review revealed Resident #6 was admitted on [DATE] with diagnoses that included Benign Prostatic Hypertrophy, Hypertension, Diverticulosis, and Hypothyroidism. A positive test result dated, 07/18/25 for Toxigenic B, C. Difficile, put Resident #6 under contact precautions. A review of Minimum Data Set (MDS) assessment, under Section C of the Brief Interview for Mental Status (BIMS), revealed a score of 11, indicating Resident #6 had mild cognitive impairment. During an observation conducted by another surveyor on 08/13/25 at 08:30 AM and at 12:50 PM, it was revealed that staff Certified Nursing Assistants (CNAs), do not contain or bag Resident #6's meal tray when they removed them from the room. In an interview conducted with the Infection Preventionist Registered Nure (IPRN) on 08/13/25 at 3:38 PM, she was asked how she educated Nurses, CNAS and other direct care staff regarding disease transmission and infection control practices, responded she provided in services about contact-based precautions, and Enhanced Barrier Precautions (EBP). When she was asked about the type of utensils and dining supplies used by Resident #6, she responded that this resident uses plastic utensils for eating, but she is not sure. When she was asked if facility staff members were in-serviced regarding containing or bagging supplies such as meal tray when leaving Resident #6's room, she responded, I provided in services for contact-based precautions . When she was asked if she had observed any meal tray removal by direct care staff from Resident #6's room, she responded she had not performed observation of staff bagging the meal tray. When she was asked if observation of facility staff member regarding infection control practices is included in her responsibility as Infection Preventionist RN, she did not respond. When asked how long Resident #6 had been in facility, she responded, since June 2025. When asked why she had not performed observation and education of direct care staff CNAs and Nurses regarding meal tray removal from Resident #6's room, she responded she had not performed these tasks because she was assigned with different tasks for the past few months. In a continuing interview conducted with the Infection Preventionist RN on 08/13/25 at 3:48 PM, when she was asked if she educated kitchen staff about infection control practices and transmission of CDI, she responded that the education is provided by the Certified Dietary Manager (CDM). During an observation conducted on 08/11/25 at 12:58 PM, there were 2 staff members helping a resident move from bed to chair using a machine, inside a resident's room. The machine had a label of Golvo 7007 ES. When the staff members were done with the bed to chair transfer, Staff I, Certified Nursing Assistant (CNA) left the room with the machine. She parked and plugged the machine in front of the Nurses' station on 08/11/25 at approximately 1:12 PM. She left the machine and stated she would wash her hands. When this surveyor asked if she was done with the machine, she responded, Yes. Staff I, CNA did not disinfect the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106047 If continuation sheet Page 15 of 16 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 08/14/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete machine after resident's usage. During another observation conducted with Staff F, Certified Nursing Assistant (CNA) on 08/14/25 at 8:57 AM, who was seen rolling a vital signs machine cart out of the resident's room. Staff F, CNA, who has been working in the facility for one year, was seen without gloves. She stopped across the Nurses' station on the second floor and was ready to leave the vital signs machine cart after parking it. She was asked by this surveyor about the care and cleaning of machine and equipment after resident's usage. She responded that she cleaned the vital signs machine cart inside the resident's room using hand sanitizer. When she was asked to repeat, she responded, I used two little hand sanitizer wipes to clean the vital signs machine cart. When she was asked if she could show this surveyor the hand sanitizer wipes, that she just used to clean the vital signs machine cart, she responded, I don't have one anymore, but I will get more from the Nourishment room. She went inside the Nourishment room and started searching for more wipes. When she could not locate them, Staff G, Registered Nurse (RN) Unit Manager, came in and helped her search for the wipes. Staff G, Unit Manager found a box of those wipes and showed them to this surveyor. The wipes came from a box with a tag, Sysco Reliance. When Staff G, Unit Manager was asked if those moist towelettes are the facility's recommended disinfectants for machines and equipment, she did not respond. When she was asked about the chemical disinfectant component of the moist towelettes, she responded that it was not written on the box. In an interview conducted with the Director of Nursing (DON) on 08/14/25 at 9:08 AM, she stated that Sysco Reliance sanitizing wipes are not the recommended disinfectant for machines and equipment for the facility. She added, those sanitizing wipes known as moist towelettes are only used for hand sanitation. In an interview conducted with the Infection Preventionist RN on 08/14/25 at 1:18 PM, who was asked about the types and names of the facility approved disinfectant for machines such as vital signs carts, Hoyer lifts, and other transfer devices, or equipment for residents' use, responded, I do not know, but the staff and DON should know. In an interview conducted with Staff L, CNA on 08/14/25 at 9:37 AM, she stated machines and other equipment used by residents are disinfected with Sani cloth disinfectants which are recognizable due to the purple top lids. She added that these wipes have a drying time of 2 minutes. She uses this disinfectant for the Hoyer lift and for the vital signs machine cart. She added that she must wait 2 minutes after disinfection with these wipes before the machine or equipment can be used by another resident. Event ID: Facility ID: 106047 If continuation sheet Page 16 of 16