Health inspection·September 7, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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, it was determined that the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior. The findings included: During the screening of residents on 09/05/23 and the Environmental Tour conducted on 09/07/23 at 10:30 AM, accompanied by the Corporate Maintenance Director and Director of Housekeeping, the following were noted: 1) Observation of the entrance to the elevator of which residents utilize to come down from the second floor resident rooms to the Skilled Therapy Gym located on the first floor was noted to have a 18 inch by 2 inch wood slat at the opening to the elevator door. Further observation noted a large lip that posed a potential trip hazard to residents entering and/or exiting the elevator. The issues was discussed with the Corporate Maintenance Director at the the time of the observation, who stated the the issues required immediate repair attention. 2) Resident Rooms: room [ROOM NUMBER] - Room walls (3) were noted to be damaged and in disrepair, large hole in wall #1, and soiled fan blowing directly towards the resident with a tracheotomy. room [ROOM NUMBER] - Room walls (3) were noted to be damaged and in disrepair, privacy curtain was soiled and stained, and night stand dresser drawers would not close. room [ROOM NUMBER] - Room walls (3) were noted to be damaged and in disrepair. room base boards in disrepair, and exterior of bathroom entry door was in disrepair. room [ROOM NUMBER] - Room walls (3) were noted to be damaged and in disrepair. room base boards in disrepair, and exterior of bathroom entry door was in disrepair. room [ROOM NUMBER] - Room walls (3) were noted to be damaged and in disrepair. room [ROOM NUMBER] - Room walls (3) were noted to be damaged and in disrepair. room [ROOM NUMBER] - Room walls (3) were noted to be damaged and in disrepair, and wall electric cover was not secured to the wall. Page 1 of 9 106109 106109 09/07/2023 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few room [ROOM NUMBER] - Large black scuff marks on walls (3), exterior of bathroom door damaged and in disrepair, and exterior of ovrbed table (B Bed) was worn and exposed wood areas. room [ROOM NUMBER] - Room walls (3) were noted to be damaged and in disrepair. room [ROOM NUMBER] - Room walls (3) were noted to be damaged and in disrepair, and bathroom door frame was rust laden. room [ROOM NUMBER] - Bathroom emergency shower call cord was wrapped around handrail. 3) Clean Supply Storage Room - Entry door not locked (broken) and potential resident access to razors (3 boxes) and dialysis chemical products (germicidal and bleach) . Soiled fan stored within the room with clean gastric and IV pumps. Following the tour conducted on 09/07/23 at 10:30 AM, the findings were again confirmed with the Regional Maintenance Director and Director of Housekeeping. The findings were also discussed with the facility's Administrative Staff. 106109 Page 2 of 9 106109 09/07/2023 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, it was determined that the facility was not disposing of garbage and refuse properly. Residents Affected - Some The findings included: During the initial kitchen/food service observation tour conducted on 09/05/23 at 9 AM accompanied with the Food Service Manager (FSM), the following was noted: Observation of the facility's commercial dumpster that is located at the facility's receiving dock on 08/05/23 at 9 AM noted that there was a large circular hole of approximately 18 inches located below the dumpster door. Further observation noted the interior to have a large build-up area of black slime within the cavity of the dumpster. It was also noted to have numerous flying insects and an offensive garbage odor. Interview with the FSM at the time of the observation revealed that the Hospital Administration had been notified numerous times over the past 2 months by the SNU (Skilled Nursing Unit) Administration that a new commercial dumpster was required for potential sanitation issues. It was also discussed with the facility Administrator that the issues concerning the improperly covered commercial linen carts are delivered by an outside vendor, directly next to the commercial dumpster. 106109 Page 3 of 9 106109 09/07/2023 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

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** 3) During a routine observation conducted on [DATE] at 7:30 AM, it was noted that a commercial sized clean linen laundry cart (full ) was located at the entry to the elevator on the first floor . The Housekeeping Director who was with the clean linen cart stated that the clean linen cart was going to be delivered to the second floor Skilled Nursing Unit. Further observation noted noted that 2/3 of the large commercial clean linen cart was not covered and much of the clean linens (Bed linens, bath linen, etc.) were exposed. The Director stated to the surveyor that the linen company is not providing enough plastic wrap to cover the entire cart during transportation and upon delivery . The Director stated he would contact the linen company concerning the issues. The surveyor requested to be informed of the linen company response. Residents Affected - Some Further investigation of the linen cart issues on [DATE] at 8:00 AM, it was noted that there were 7 linen carts which were stored in the first floor hall of the hosptial were not properly covered. It was also noted during the observation that the clean linen carts are delivered to the hospital receiving dock and have to be transported through the soiled room/infectious waste room. Observation of the soiled room on [DATE] at 8:30 AM noted the walls and floors were heavily soiled and stained (Photographic evidence of linen carts and soiled room obtained). During an interview conducted with the representative of the Linen Vendor Accounts Manager on [DATE] at 1:00 PM, she noted to state that she has revived the clean linen process and stated the company was not using the correct size plastic covers to ensure the entire cart and clean linen contents were properly covered during transport and delivery. Based on review of policy and procedure, observation, interview and record review, the facility failed to 1) follow infection control standards for 1 of 1 sampled residents observed, during a Medication Administration Observation (Resident #181); 2) ensure that it followed infection control standards for 1 of 1 sampled residents observed were followed during a Glucometer Observation (Resident #78), and; 3) transport and store resident linens, in a sanitary manner. The findings included: Review of the facility policy and procedure titled, Infection Prevention and Control Program provided by the Director of Nursing (DON) with a release date of 11/2022 documented in the Policy Statement: An Infection Prevention and Control Program is designed to maintain a safe, sanitary, and comfortable environment involving each department. Definitions: Staff----All facility staff (direct and indirect) .others who provide care and services to patients on behalf of the facility Hygienically clean refers to being free of pathogens in sufficient numbers to cause human illness .Standards Precautions .is based on the principle that all blood, body fluids, secretions, excretions except sweat, regardless of whether they contain visible blood, non-intact skin, and mucous membranes may contain transmissible infectious agents. Furthermore, equipment or items in the patient's environment likely to have been contaminated with infectious body fluids must be handled in a manner to prevent transmission of infectious agents Review of the facility policy and procedure titled, Blood Glucose Monitoring using a NovaStat Strip Glucometer provided by the Director of Nursing (DON) with a release date of 10/2022, documented in the Policy Statement: Policy [NAME] Subacute Units monitors blood glucose monitoring according to 106109 Page 4 of 9 106109 09/07/2023 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Physician's Orders. Rational Blood glucose tells what the blood glucose is at any given time and is the main tool to monitor Diabetes control .6. Prior to initial blood glucose monitoring or storage in the docking/charging station, cleanse exterior of Glucometer with 10% Bleach wipe and dry with damp non-sterile cloth (gauze) .Patient Testing 3. Place cleaned machine on barrier on table/cart .25. Clean the Glucometer using a 10% Bleach solution moistened wipe between each patient. Allow appropriate contact time according manufacturer's recommended for solution being used and wipe any residual Bleach solution off the meter after appropriate contact time . Review of the facility's Policy and Procedures for Linen Handling and Storage noted the following: Purpose: Minimize microbial contamination of linen due to surface contact or airborne disposition Policy: Ensure the proper storage and handling of clean linen. Procedure: 1) All clean linen carts shall be delivered to user areas in covered carts. 1.1; Linen will be covered at all times during transport to user areas. 1.3: Clean linen carts in user areas shall be in enclosed closets or stored with covers. 1) Resident #181, was admitted to the facility on [DATE] with diagnoses which included Displaced Intertrochanter Fracture Left Femur, Anemia, Dysphagia, Anxiety Disorder, Major Depressive Disorder, Adjustment Disorder and Hypertension. He had a Brief Interview Mental Status (BIMS) score of 15 (cognitively intact). On [DATE] at 9:24 AM, during a Medication Administration observation, Resident #181's dirty open and uncovered urinal (not actively or recently in use by the resident) was observed sitting atop his bedside table adjacent to his clean half-lidded water pitcher with the end of an exposed drinking straw sticking out of the top of the water pitcher, for a period of over one (1) hour; several staff members were observed entering and exiting the resident's room, with no attempts to remove the resident's urinal to a different location (Photographic Evidence Obtained). An interview was conducted on [DATE] at 3:21 PM with Staff B, CNA, in which she was asked about Resident #181's dirty open and uncovered Urinal (not actively or recently in use) sitting atop his bedside table adjacent to his clean half-lidded water pitcher, and if it was acceptable infection control practice and she acknowledged that the urinal should not have been left next to the resident's water pitcher. An interview was conducted on [DATE] at 3:22 PM with Staff C, RN, in which she was asked about Resident #181's dirty open and uncovered Urinal (not actively or recently in use by the resident) sitting atop his bedside table adjacent to his clean half-lidded water pitcher, and if it was acceptable infection control practice and she acknowledged that the urinal should not have been left next to the resident's water pitcher. An interview was conducted with RN, Nurse Manager, on [DATE] at 3:30 PM regarding the Resident #181's dirty open and uncovered Urinal (not actively or recently in use by the 106109 Page 5 of 9 106109 09/07/2023 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0880 resident) sitting atop his bedside table adjacent to his clean partially-lided water pitcher and if Level of Harm - Minimal harm or potential for actual harm it was acceptable infection control practice and the RN, Nurse Manager also acknowledged that the urinal should not have been left next to the resident's water pitcher. Residents Affected - Some 2) Resident #78 was admitted to the facility on [DATE] with diagnoses which included Unspecified Carpal Bone Right Wrist, Diabetes Mellitus Type II, Chronic Kidney Disease Stage 3, Hypertension and Gastroesophageal Reflux Disease. She had a Brief Interview Mental Status (BIMS) score of 15 (cognitively intact). Record review revealed on [DATE] the physician order documented for Accuchecks to be performed four (4) times per day, before meals and at bedtime. On [DATE] at 11 AM, during a Glucometer Observation with Staff D, RN, was conducted for Resident #78. The nurse donned a clean pair of gloves after washing her hands for approx. 35-40 seconds and she cleaned the Glucometer with Sanicloth (bleach) wipes and allowed it to air dry for 2-4 minutes. She then removed her gloves and sanitized her hands and gathered the supplies and went to the resident and she agreed to have this surveyor observe the Glucometer being performed. The nurse then washed her hands again for 30-45 sec and donned a clean pair of gloves and proceeded to take the resident's blood sugar level from the left-hand index finger. After receiving the results, the nurse threw the used lancets into the sharp's container, removed her gloves and washed her hands for approx. 35-40 seconds, the nurse was then observed to proceed to the next resident to administer their medications after having placed the dirty/used Glucometer machine on top of medication cart #1. Further observation revealed Staff D did not clean and sanitize the Glucometer again with bleach wipes after completing the Glucometer check until after surveyor inquisition/intervention(Photographic Evidence Obtained). During a brief interview conducted with Staff D, on [DATE] at 11:05 AM, she acknowledged that she had forgotten to clean the Glucometer after resident use, and said that she should have. An interview was conducted with the RN, Nurse Manager, on [DATE] at 3:30 PM regarding the Glucometer not being cleaned. The RN, Nurse Manager acknowledged that the Glucometer should have been cleaned and sanitized after resident use. An interview was conducted on [DATE] at 3:35 PM with the DON regarding Resident #181's dirty open and uncovered Urinal (not actively or recently in use by the resident) sitting atop his bedside table, adjacent to his clean partially lided water pitcher. She acknowledged that the urinal should not have been left next to the resident's water pitcher, and further acknowledged and recognized that the Glucometer should have been cleaned and sanitized after resident use; this was not done. 106109 Page 6 of 9 106109 09/07/2023 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, it was determined that the facility failed to ensure the kitchen air-conditioning vents (2) and commercial food preparation equipment (steamers X 2) were not in safe operating condition. This effected potentially 23 of the 25 facility residents. Residents Affected - Some The findings included: During the initial kitchen/food service observation tour conducted on 09/05/23 at 9 AM and accompanied with the Food Service Manager (FSM), the following were noted: 1) Two ceiling mounted kitchen air-conditioning vents located in the food preparation area were noted to have a large build-up of condensation. Continued observation noted that the condensation build-up was dripping down onto prepared foods, food preparation surfaces and tables, and staff. It was discussed with the Food Service Manager (FSM) that the dripping condensation could potentially result in food contamination. The FSM stated that the condensation issues was reported to maintenance 1-2 months ago without repair or resolution. 2) Observation of the commercial steamers noted that 1 of the 2 steamers was not working while the other was not working properly. Interview with the cook at the time of the observation noted that foods must be streamed hours in advanced to be properly cooked. It was discussed with FSM that continued cooking and holding of foods will negatively effect the nutritive and appearance of foods. The FSM further stated that the steamer issues was reported 1-2 months ago without or repair or resolution. The issues were discussed with the Hospital Administration on 09/06/23 at 1:00 PM, who confirmed that they were aware of the air-conditioning ventilation issues and the non-operational commercial food steamers for the last 2 months, but had not resolved and repaired the issues. * Photographic Evidence Obtained 106109 Page 7 of 9 106109 09/07/2023 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0914 Provide bedrooms that don't allow residents to see each other when privacy is needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to equip 12 semi-private resident rooms with ceiling suspended curtains that assure full privacy for 21 of 21 facility residents. Residents Affected - Some The findings included: During the screening of residents and room observations conducted on 09/05/23, it was noted that the privacy curtains located within semi-private resident rooms did not provide full privacy for the 21 of 21 residents. The surveyor requested that the Housekeeping Director tour the resident rooms to identify the room privacy curtain issues. The rooms identified with the director included the following: room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - not occupied) room [ROOM NUMBER]: (Semi Private - two beds - only 1 occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) room [ROOM NUMBER]: (Semi Private - two beds - occupied) Following the observation an interview was conducted with the Director of Housekeeping and the following was revealed: < Each semi-private room should have been equipped with 2 privacy curtains per resident (total of 4/room) to ensure full privacy. < Privacy curtains over a period of time had been removed for cleaning, replacement, etc. however they were not put back up in the semi-private resident rooms. 106109 Page 8 of 9 106109 09/07/2023 Kindred Hospital South Florida Hollywood 1859 Van Buren St Hollywood, FL 33020

F 0914 Level of Harm - Minimal harm or potential for actual harm < There was a adequate supply of privacy curtains for every resident room in storage at the facility on 09/05/23. < There was an insufficient supply of hooks to hang the privacy curtains in in each semi-private room (30 hooks) . Residents Affected - Some < The lack of privacy curtains was estimated to effect 21 of the 25 facility residents. * Photographic Evidence Obtained 106109 Page 9 of 9