Inspection·September 7, 2023

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide Range of Motion (ROM) devices and therapy to prevent deformities for 1 of 2 sampled residents for ROM (Resident #19). The findings included: Resident #19 was readmitted on [DATE] with diagnoses of Brain Damage, Respiratory Failure, and Drowning. The care plan initiated on 05/30/20 showed that he will maintain the current range of motion in all extremity stimulation. He will be provided with 2-4 times a week for physical management, and all his positioning needs will be addressed. It further showed that the physical therapy will follow the prescribed plan. In an observation conducted on 09/06/23 at 7:20 AM, Resident #19 was noted in bed. Closer observation showed no ankle foot orthosis (AFO) in place. In an observation conducted on 09/06/23 at 8:30 AM, Resident #19 was noted in bed. Closer observation showed no ankle foot orthosis (AFO) in place. In an observation conducted on 09/06/23 at 9:00 AM, Resident #19 was noted in bed. Closer observation showed no ankle foot orthosis (AFO) in place. In an observation conducted on 09/06/23 at 10:30 AM, Resident #19 was noted in bed. Closer observation showed no ankle foot orthosis (AFO) in place. In an observation conducted on 09/06/23 at 1:00 PM, Resident #19 was noted in bed. Closer observation showed no ankle foot orthosis (AFO) in place. In an observation conducted on 09/06/23 at 2:00 PM, Resident #19 was noted in bed. Closer observation showed no ankle foot orthosis (AFO) in place. In an observation conducted on 09/06/23 at 3:00 PM, Resident #19 was noted in bed. Closer observation showed no ankle foot orthosis (AFO) in place. A review of the Physician's orders showed an order for AFOs to be worn daily for at least 8 hours, including when in bed or in a wheelchair. One a day to maintain current ROM and prevent further deformities dated 06/25/23. A review of the Prescription and certificate of Medical Necessity dated 09/07/22 showed that Resident #19 has no active movement and passive range of motion is difficult in flexion of ankles. Orthotics for ankles are necessary in the prevention of ROM. A review of the Treatment Administration Record documented that on 09/06/23, the AFOs were placed on Resident #19 at 8:00 AM. In an interview conducted on 09/07/23 at 8:55 AM, Staff B, a Registered Nurse, stated that Staff A, a Therapy Technician, comes into the Nursery daily to place the AFOs on Resident #19. She further said that she observed that the AFOs were placed on Resident #19 on 09/06/23 at around 8:00 AM. Staff B reported that she was assigned to Resident #19 on 09/06/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 2 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview conducted on 09/07/23 at 9:03 AM, the Physical Therapist reported that Staff A provides passive ROM therapy and places the ROM devices daily to all the kids in the Nursery. In an interview conducted on 09/07/23 at 9:06 AM, Staff A stated that she follows a schedule each day for the different kids that need to be seen. She is responsible for placing the AFOs on Resident #19 and providing the passive ROM with Resident #19. Staff A follows therapy orders and directions of use given to her by the Physical Therapist. She waits after morning care to place the AFOs on Resident #19. Staff A reported that she put the AFOs on Resident #19 at 11:00 AM yesterday and that it was on for 4 hours. It was further said that Resident #19 gets passive ROM therapy every day and that she documents her therapy times on a log that is later given to the Physical Therapist. When asked when Staff A puts the AFOs on Resident #19, she said only when he is out of bed and in his wheelchair. A review of the plan of care provided by Staff A showed that the upper and lower extremities' passive range of motion would be provided for up to 2 to 4 times a week as tolerated. A review of the log for therapy services provided by Staff A showed that for the month of June 2023, Resident #19 received therapy four times in total. For the month of July 2023, Resident #19 received therapy four times in total. For the month of August 2023, Resident #19 received therapy five times in total, and for the first week of September 2023, only once in 7 days. Another interview conducted with the Physical Therapist on 09/07/23 at 9:51 AM stated that Resident #19 is getting a passive range of motion with Staff A, two times a week. Staff A provides the therapy, and it is documented in her own calendar, which is not given to her. The AFOs are placed on Resident #19 to prevent further deformities of the feet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 3 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 provide nutritional interventions in a timely manner for 1 of 2 sampled residents for nutrition (Resident #19). Residents Affected - Few The findings included: A review of the facility ' s policy titled Weights, Heights, and Head Circumference, revised on 01/2021, showed that it is the policy of the facility to obtain and monitor weights. In an observation conducted on 09/05/23 at 10:37 AM, Resident #19 was noted in his bed. Closer observation showed a tube feeding with formulary (Pediasure Peptide) running at 45 milliliters (ml) an hour. Resident #19 was readmitted on [DATE] with diagnoses of Brain Damage, Respiratory Failure, and Drowning. The care plan initiated on 05/27/20 showed that Resident #19 requires tube feeding to maintain nutritional status. This was related to brain injury and tracheostomy dependence. The doctor's orders showed an order for weekly weights for a weight loss plan dated 07/05/23. Another order was noted for Pediasure Peptide 1.0 at 45 ml an hour running for 20 hours, which was dated 08/04/23. A review of the weights showed the following: on 07/12/2023, a weight of 28.11 kilograms; on 07/19/23, a weight of 27.27 kilograms; on 07/26/23, a weight of 28.1; on 08/02/23, a weight of 27.04 kilograms, on 08/16/23 (which was 14 days later) a weight of 27.42 kilograms, on 08/23/23 a weight of 27.5 kilograms and 08/30/23 a weight of 27.7 kilograms. The Nutrition assessment dated [DATE] showed that Resident #19 received tube feeding Pediasure Peptide, 1.0 at 60 ml an hour times 22 hours. This note showed an increase of 18.2% in weight gain in 180 days with extreme obesity and significant fat storage. It further revealed that Resident #19 ' s weight will be monitored and that he is meeting his estimated needs on his current tube feeding regimen. The next follow-up Nutrition Assessment was on 03/13/23, which showed the following: Resident #19 had a significant weight gain of 25% in 180 days. He is extremely obese and has a low activity level and energy expenditure. Considering the significant weight gain, decreasing the current tube feeding to Pediasure Peptide 1.0 to 45 ml an hour times 22 hours was recommended. Further review of the physician ' s orders showed that this recommendation was only placed on 03/20/23, which was seven days later. The next follow-up Nutrition Assessment (3 months later) dated 06/12/23 showed the following: Resident #19 was on tube feeding Pediasure Peptide 1.0 @ 45 ml an hour for 20 hours. Resident #19 had a significant weight gain of 26.9% in 180 days. It further showed that he was extremely obese with significant fat stores. It further showed that the doctor decreased tube feeding due to weight gain, and weight loss was in the plan toward normal body weight. No other tube feeding changes were made at this time. The care plan dated 06/12/23 showed to weigh resident weekly as ordered. It also showed to continue (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 4 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 tube feeding of Pediasure Peptide 1.5 as ordered (which was not the accurate order). Level of Harm - Minimal harm or potential for actual harm In an interview conducted on 09/06/23 at 8:20 AM, the Consultant Dietitian stated that the nursing team takes weekly and monthly weights, and they are the ones who record the weights in the electronic system. Residents Affected - Few Another interview conducted on 09/06/23 at 9:00 AM with the Consultant Dietitian stated that the doctor was concerned that Resident #19 was gaining too much weight and decided to put him on a weight loss program. According to the Consultant Dietitian, Resident #19 was on Pediasure Peptide tube feeding at 60 ml an hour times 22 hours, and the doctor decreased the tube feeding order to 45 ml an hour times 20 hours in her assessment on 03/13/23. When asked why it took seven days to place the new tube feeding recommendation in the electronic system, she did not know. The Consultant Dietitian reported that she writes her nutritional recommendations on a physician order sheet, which is then given to the Case Manager. The Case Manager is responsible for getting it approved by the doctor. The Consultant Dietitian said that if the doctor happens to be in the facility while she is there, she will ask the doctor in person. When asked what the best practice is when following weight gain in the residents, she said that they need to be followed monthly and not quarterly. When asked as to why Resident #19 ' s weekly weight order was only placed on 07/05/23 and not earlier, she did not know. The Consultant Dietitian revealed that Resident #19 metabolic needs are very low and that he is basically not burning any calories. This is why weight gain is a challenge for Resident #19. In an interview conducted on 09/06/23 at 12:05 PM with the Case Manager, she stated that any nutritional recommendations that the Consultant Dietitian gives are given to her, and she is responsible for placing them in the electronic system and leaving the doctor a note to sign off the orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 5 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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** 4.) Resident #237 was admitted to the facility on [DATE] with Tracheostomy and Gastrostomy Status diagnoses. An order was noted for tube feeding Nutren [NAME] (tube feeding formulary) at 54 milliliters (ml) an hour continuously dated 07/24/23. The care plan dated 05/31/23 showed that Resident #237 requires tube feeding to maintain nutritional status with expected fluctuation in weight loss. It further showed to follow enteral feeding as ordered. In an observation conducted on 09/05/23 at 2:15 PM, Resident #237 was noted in bed with the tube feeding bag off. Closer observation showed an empty bag with Nutren [NAME] written on it at 54 ml an hour. In an interview conducted on 09/05/23 at 2:30 PM with Staff D, a Registered Nurse, she was asked what is the tube feeding order for Resident #237. She said that she needed to verify the order in the electronic system. She located the order in the system and said that Resident #237 is on Nutren [NAME] tube feeding formulary. Staff D proceeded to show the Surveyor the supply room for a new bag of tube feeding. Continued observation of the supply room revealed that they did not have any more Nutren [NAME] tube feeding in stock. Staff D stated that she would look in the electronic system for any substitution order for the tube-feeding formula but was not able to find a substitution order for the tube-feeding Nutren [NAME]. In an observation conducted on 09/05/23 at 2:42 PM, Staff D asked the facility Case Manager if they had any Nutren [NAME] tube feeding in-house, and the Case Manager was surprised to find out that they were out of that specific tube feeding formula. In this observation, the Case Manager stated that they would need to call the Clinical Dietitian to get a substitution order in place. In an interview conducted on 09/05/23 with the Registered Dietitian at 4:16 PM, she stated that they have different types of tube feeding products, and they may have only some of them in-house. This is why she will write substitution orders in place if it is needed. The nursing staff will reach out to her to change the tube feeding formula or provide a formula substitution. The Case Manager will call her for any tube feeding that is out of stock; she will try and write orders for the in-house tube feeding types. In an interview conducted on 09/05/23 at 4:20 PM, with the Case Manager, she stated that she needs to keep an inventory list of the amount of tube feeding that is needed in-house. She will reach out to the off-site warehouse for tube feeding deliveries that are made three times a week, on Mondays, Wednesdays, and Fridays. The Case Manager was not aware that this specific tube feeding was on backorder, and because of the holiday weekend, she only read the email today. She expects the nursing staff to reach out to her if a tube feeding formula is out of stock or missing. The next step would be to reach out to the Clinical Dietitian for further recommendations or check for any additional substitution orders. She further acknowledged that they did not have any Nutren [NAME] tube feeding in-house. In an interview conducted on 09/05/23 at 4:35 PM, with Staff G, Registered Nurse stated that she started her shift at 7:00 AM this morning. The tube feeding was already running for Resident #237 when (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 6 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 she came this morning, and she was not sure when it was started. Staff G reported that the feeding has to be in place for 24 hours with the same tube feeding formulary, and when it runs low, they are supposed to supply another batch of tube feeding from the supply room. She will let the Case Manager know if they are out of a specific tube-feeding formula. Most of the time, all tube feeding orders already come with substitution orders in case they are out of any tube feedings. Residents Affected - Few In an observation conducted on 09/06/23 at 7:14 AM, Resident #237 was noted asleep in bed, facing face down and flat on his bed. Continued observation showed that the tube feeding ran with Nutren [NAME] Fiber (tube feeding formulary) at 54 ml an hour. In an interview with Staff E, Activity Aid, on 09/07/23 at 11:45 AM, she stated that when she sees that the tube feeding is connected and running, the resident's heads need to be elected. She further said that she would stop the tube feeding to reposition the head if needed. A review of the Nutrition assessment dated [DATE] showed that Resident #237 had a weight loss of 5.4% in 90 days. It further showed that Resident #237 can meet estimated needs on the current tube feeding as ordered. 5.) Resident #137 was admitted to the facility on [DATE] with a diagnosis of Dysphagia and depended on tube feeding. The care plan initiated on 08/09/23 showed that Resident #137 requires tube feeding to maintain nutrition and hydration. It further showed that Resident #137 will have a weight gain for growth and provide tube feeding as ordered. A review of the physician's order showed an order for Neocate Infant (tube feeding formulary) with 72 milliliters (ml) every 3 hours. It further showed an order for P.O. (oral) feeding with 10 ml when awake and to turn off the feeding pump one hour before feedings two times a day dated 08/08/23. In an observation conducted on 09/05/23 at 10:37 AM, Resident #137 was noted in bed. Closer observation showed a tube feeding bag that started on 09/05/23 with no time stamp. The tube feeding bag was noted with Neocate Infant at 72 ml an hour, which was not running. In another observation conducted on 09/05/23 at 1:15 PM, the tube feeding was not running. In an observation conducted on 09/05/23 at 1:25 PM, Resident #137 was noted in bed. Closer observation showed a tube feeding bag that started on 09/05/23 with no time stamp. The tube feeding bag was noted with Neocate Infant at 72 ml an hours which was not running. In an observation conducted on 09/05/23 at 2:20 PM, the tube feeding was noted to be running with Neocate infant at 72 ml an hour with a start time of 1:00 PM. The earlier tube feeding observation conducted at 1:25 PM did not show that the tube feeding was running for Resident #137. In an interview conducted on 09/05/23 at 2:23 PM with Staff D, the Registered Nurse stated that she was not the one who started the new tube feeding bag at 1:00 PM. She further said that the tube feeding for Resident #137 should be running at 72 ml an hour every 3 hours continuously for 24 hours. In an interview conducted on 09/05/23 at 2:45 PM with Staff C, a Registered Nurse stated that Resident #137 is tolerating the tube feeding well and that they are receiving the tube feeding continuously every 3 hours with 72 ml every 3 hours. She further said that they would refill the bag when the tube-feeding formula empties out. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 7 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 In an interview conducted on 09/05/23 at 2:50 PM, with Staff E, Activity Staff said that she feeds Resident #137 with the nipple every day at around 11:00 AM and stops the tube feeding 1/2 hour before. Staff D then corrected her and said that she had stopped the tube feeding one hour before. Based on record review, observations and interviews, facility failed to: (1) ensure that the administration of enteral nutrition was consistent with the practitioner's orders for 5 of 8 sampled reisdents (Resident #5, #18, #23, #137 and #237); (2) ensure that water ordered for flushes was administered per orders for 3 of 8 sampled residents; and (3) ensure the use of mixed enteral nutrition was consistent with the facility's policy for 1 of 8 sampled residents (Resident #23). The findings included: Review of the facility's policy titled Nasogastric/Gastrostomy Tube Feeding reviewed on 03/2022 documents .administration bag and tubing must be marked with the date and changed every twenty-four (24) hours .feeding preparations which involve blending, reconstitution .may hang for up to eight (8) hours .prepared feeding solutions must be refrigerated if held before used . 1.) Review of Resident #5's clinical record documented an admission on [DATE] and latest readmission on [DATE]. The resident diagnoses included Feeding Difficulties, Anemia, Gastrostomy Status, Aphasia, and Disorders of Bone Density and Structure. Review of Resident #5'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 needed total assistance from the staff to complete the activities of daily living. Review of Resident #5's care plan titled Tube required to assist resident in maintaining nutritional status related to: diagnosis of Short Gut Syndrome. Receives Enteral feeds for 100% of her nutritional and hydration needs initiated on 02/15/19. The care plan interventions included: Administer feeding as ordered . Review of Resident #5's physician order dated 08/02/23 documented FORMULA: Nutren [NAME] 230mL every three hours via G-tube (gastrostomy tube) . Administer via feed pump over an hour every three (3) hours. Review of Resident #5's physician order dated 01/27/23 documented Administer water flush 90 millimeters (ml) via G-tube three (3) times daily for hydration. Review of Resident #5's Treatment Administration Record (TAR) for September 2023 documented FORMULA: Nutren [NAME] 230mL every three hours via G-tube (gastrostomy tube) . Administer via feed pump over an hour every three (3) hours. The administration record was initialed as administered as ordered. On 09/05/23 at 1:51 PM, observation revealed Resident #5's G-tube feeding Nutren [NAME] formula running at a rate of 250 ml/per hour, every four(4) hours. The bag had approximately 250 ml to be infused. The resident's water flush was running at 200 ml per hour every four (4) hour. The bag of water was not marked with a date. On 09/06/23 at 9:27 AM, observation revealed Resident #5 in the classroom connected to the feeding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 8 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 pump. Observation revealed tube feeding Nutren [NAME] formula running at a rate of 250 ml/per hour, every four(4) hours. The bag had approximately 200 ml to be infused and was not marked with a starting time . The resident's water flush was running at 200 ml per hour every four (4) hour. The bag of water was not marked with a date or time started. On 09/06/23 at 12:32 PM, observation revealed Resident #5 in the classroom and connected to the tube feeding Nutren [NAME] Fiber formula running at 230 ml/hr. The bag had 600 ml to be infused. The resident's water flush was running at 200 ml per hour every four (4) hour. The bag of water was not marked with a date or time started. On 09/06/23 at 12:58 PM, a side by side review of Resident #5's physician orders was conducted with Staff M, Registered Nurse (RN) who read Nutren [NAME] at 230 ml/over one (1) hour every three (3) hours; water flush 90 ml three (3) times daily. Staff M stated that the TAR will tell her Resident #5's feeding and water administration times. Staff M stated that Resident #5's tube feeding was due at 9:00 AM and she will shut it off at 12:00 PM and will connect again at 3:00 PM. Staff M stated the feeding machine was supposed to shut off by itself. Staff M asked for Staff L, Residents Care Manager to help her with the feeding pump. On 09/06/23 at 1:25 PM, a side by side review of Resident #5's running tube feeding rate and water flush rate was conducted with Staff L and Staff M. Staff L, stated that Resident #5's water flush was supposed to be at 90 ml per hour not at 200 ml per hour as it was set up. On 09/06/23 at 1:50 PM, an interview was conducted with the Registered Dietitian (RD) who stated that Resident #5 was getting Nutren [NAME] five (5) times daily. The RD stated regarding the water flushes, the resident gets free water in the formula plus 90 ml three (3) times daily for water flushes. Photographic evidence of Resident #5 receiving wrong formula and water flushes rate on 09/05/23 and wrong water flushes on 09/06/23. The RD stated there was a fine line between been under or over fluids because the residents were fragile. The RD added that the nurses needed to check resident's feeding and water flushes rates to make sure it was infused as per physician orders. 2.) Review of Resident #18's clinical record documented an initial admission on [DATE] and latest readmission on [DATE]. The resident diagnoses included Contracture, Lobar Pneumonia, Pulmonary Mycobacterial Infection, Anoxic Brain Damage, Aphasia, Dependence on Respirator [Ventilator] Status, Gastrostomy Status, Disorders of Bone Density and Structure, [NAME]-Parkinson-White Syndrome, Tracheostomy Status, and Accidental Drowning. Review of Resident #18 MDS quarterly assessment dated [DATE] documented a BIMS score of 0 indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed total assistance from the staff to complete the activities of daily living. Review of Resident #18's care plan titled Current nutritional problem related to Enteral Nutrition required to assist resident in maintaining nutritional status .patient has a GJ-tube . initiated on 01/13/20. The care plan interventions included: .administer enteral nutrition) .as prescribed in the specified times when applies . Review of Resident #18's physician order dated 08/21/23 documented FORMULA: Peptamen 1.0 at 100 ml/ (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 9 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 per hour continuously via J-Tube for 18 hours. On at 12:00 PM and OFF at 6:00 AM. Level of Harm - Minimal harm or potential for actual harm Review of Resident #18's physician order dated 04/07/23 documented water flush 200 ml every six (6) hours via J-tube. Residents Affected - Few On 09/05/23 at 1:19 PM, observation revealed Resident #18's tube feeding was not connected to the resident and the feeding pump was turned off. Further observation revealed the resident water flushes bag was not marked with a date or time. The resident's tube feeding was supposed to start at 12:00 PM as per physician order. On 09/05/23 at 1:43 PM, observation revealed Resident #18's tube feeding formula rate running at 110 ml/per hour. The physician order read feeding formula to be infused at 100 ml per hour. Further observation revealed the resident water flushes bag continue to be unmarked. On 09/06/23 at 10:35 AM, observation revealed Resident #18 tube feeding formula running at 110 ml/hr. Further observation revealed the resident's water bag and the formula bag were not marked with a date and time. On 09/06/23 at 11:30 AM, a side by side review of Resident #18's tube feeding was reviewed with Staff M, RN. Staff M confirmed that the formula and the water bag were not labeled and added that the formula could be anybody's formula. Staff M stated the water and the formula bags were hanged this morning before 7:00 AM by the night shift nurse. Staff M added she did not notice the bags were not marked/labeled. Staff M confirmed Resident #18's feeding rate at 110 ml per hour. Staff M stated Resident #18's feeding physician's order was Peptamen 1.0 at 100 ml per hour continuously for 18 hours, on at 12:00 PM and off at 6:00 AM by way of J-tube. An inquiry was made regarding Resident #18's tube feeding formula running at the time of interview when it was supposed to be off. Staff M stated it was off at 7:00 AM during rounds and that she administered the resident's 8:00 AM medications. Staff M stated she did not remember connecting the resident back to his feeding after medications administration. Staff M added it was an oversight on my part. Staff M was asked who could reconnected the resident feeding and stated a lot of people go in and out of his room. Subsequently, observation revealed Staff M obtained a label and labeled Resident #18's feeding and water bag. Staff M did not discard the formula in the bag. On 09/06/23 at 2:05 PM, an interview was conducted with the Registered Dietitian (RD) who stated Resident #18s physician order for the tube feeding was Peptamen at 100 ml per hour continuously for 18 hours. The RD stated that she recommended to decrease the resident's tube feeding rate because of weight gain. The RD was apprised that Resident #18's feeding rate was at 110 ml/per hour on 09/05/23 and 09/06/23. 3.) Review of Resident #23's clinical record documented an admission on [DATE] and a latest readmission on [DATE]. The resident diagnoses included Chromosomal Abnormality, Spastic Quadriplegic Cerebral Palsy, Unspecified Lack of Expected Normal Physiological Development in Childhood, Feeding Difficulties, Gastrostomy Status, Chronic Respiratory Failure, Obstructive Sleep Apnea, Gastro-Esophageal Reflux Disease, Convulsions, and Nephrotic Syndrome. Review of Resident #23's MDS quarterly assessment dated [DATE] documented a BIMS score of 0 indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed total assistance from the staff to complete the activities of daily living. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 10 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 Review of Resident #23's care plan titled The resident is at nutrition and hydration risk due to severe developmental delays, cerebral palsy, swallowing and chewing problems and EN (enteral nutrition) dependent. Has PEG (tube feeding) present for all nutrition and hydration needs. The care plan was initiated on 04/24/21 and included interventions as .provide enteral feeding and flushes as ordered . Review of Resident #23's physician order dated 07/26/22 documented Neocate [NAME] 30 kcal 250 ml via tube feeding four (4) times during the day. Mixing instructions: Neocate [NAME] 21 scoops with 21 ounces (630 ml) of water four times a day for nutrition run over the pump. Review of Resident #23's physician order dated 01/11/23 documented Water flushes 200 ml four (4) times a day via tube feeding for hydration. On 09/05/23 at 4:05 PM, observation revealed Resident #23's connected to the feeding pump and to the formula bag labeled Neocate [NAME] dated 09/05/23 7:00 AM. The resident's formula was running at 230 ml per hour every three (3) hours and the water flush at 90 ml per hour every eight (8) hours The amount of the formula was not marked in the bag. The facility policy documented that a feeding preparation that involves reconstitution may be hang for eight (8) hours. On 09/06/23 at 8:37 AM, during Resident #23's medication administration performed by Staff M, RN, observation revealed the resident had a feeding formula bag dated 09/06/23 5:00 AM. The resident's water bag had 725 ml and was not labeled. Staff M confirmed that the formula bag had approximately 950 ml in the bag. During an interview, Staff M stated that Resident #23's formula was prepared by the night shift nurse at 5:00 AM, as labeled and runs at 230 ml per hour every 3 hrs. Staff M stated that the resident water flush was at 90 ml per hour every eight (8) hours. Staff M reviewed the physician's order and stated that the resident's water flush was supposed to be 200 ml and that she had to fix the machine (pump). Observation revealed Staff M adjusting Resident #23's feeding and water flush pump's rate. Staff M stated she will get some help to set up the machine. On 09/06/23 at 9:06 AM, observation revealed the Director of Nursing (DON) entered Resident #23's room. The DON was observed setting up the feeding pump with Staff M. On 09/06/23 at 12:38 PM, observation revealed Resident #23 in the classroom. The resident's formula bag had approximately 950 ml of formula left to be infused. The bag was labeled 09/06/23 5:00 AM. The feeding pump showed running at 250 ml/hr. On 09/06/23 at 1:06 PM, an interview was conducted with Staff M, RN who stated she connected Resident #23's formula set up by night shift at 9:06 AM. Staff M stated the resident's feeding times was scheduled at 8:00 AM, 12:00PM; 1500 and 1800. Staff M stated that she will administer next feeding at 12:00 PM, let it run for one hour and around 1:00 PM she will disconnect it. Staff M stated the resident should have 500 ml infused of the feeding formula by 1:00 PM. On 09/06/23 at 1:20 PM, a side by side review of Resident #23's formula infusion was conducted with Staff L, Resident Care Manager and Staff M, RN. Staff L was apprised that Resident #23's had approximately 900 ml of feeding formula in the bag since 9:00 AM. Staff L reviewed the formula infusion history and stated that the resident received 14 ml of feeding formula in the last five(5) hours. Staff L was apprised that the resident was scheduled to have 250 ml of her feeding at 8:00 AM and 12 noon and was connected at 9:00 AM and the feeding pump was reading running at 0 ml per hour. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 11 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 On 09/06/23 at 1:39 PM, an interview was conducted with the RD who confirmed Resident #23's administration of the tube feedings times as 8:00 AM, 12:00 PM, 1500 hours (3:00 PM), 1800 (6:00 PM) and 2030 (8:30 PM) of 250 ml of Neocate [NAME] infused in one (1) hour. The RD stated the resident would have 500 ml feeding infused by 1:00 PM. The RD was apprised that the resident received 14 ml of her feeding formula as per the feeding pump infusion history reviewed with Staff L. The RD stated there was opportunities for improvement. On 09/07/23 at 4:16 PM, a side by side review of Resident #23's running formula with the DON and Staff N, RN was conducted. The resident's formula bag had approximately 50 ml to be infused. Staff N stated that the night shift nurse filled the bag and that she administered three (3) 250 ml of the formula each in her shift. The bag was filled up for more than 750 ml. A review of the facility policy was conducted with the DON. The policy stated that feeding preparations which involve blending, reconstitution or periodic addition of more formula, may hang for up to eight (8) hours. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 12 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record and policy review, the facility failed to follow up with pharmacy recommendations for 3 of 5 residents sampled for unnecessary medications (Resident #1, #6 and #30). The findings included: The facility's policy titled Consultant Pharmacists Monthly Drug Regimen Review dated 9/2018 and reviewed 4/2020 revealed Physicians/prescribers are to act on recommendations by their NEXT visit date to the facility. If they do not act on recommendations by their next visit, the D.O.N. will promptly forward those recommendations to the Medical Director for follow up .The D.O.N. will be responsible to ensure that documentation is completed to verify the Consultant Pharmacist Recommendations are acted on with a target completion timeframe of TWO weeks from the report date. D.O.N. is Director of Nursing. 1. Resident #1 was admitted to the facility on [DATE]. Diagnoses included Dependence on Respirator, Arthrogryposis Multiplex Congenita and Epilepsy. Arthrogryposis Multiplex Congenita is a term used to describe a variety of conditions involving multiple joint contractures. Resident #1 had a Brief Interview for Mental Status (BIMS) of 15 per a quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 07/30/23. This indicated the resident is cognitively intact. On February 14, 2023 the consultant pharmacist made a recommendation for Restoril 30mg (milligrams) is currently ordered routinely for this resident. Doses of Restoril greater than 15mg a day are not recommended in the elderly due to increased risk of adverse consequences. If unable to reduce or DC (discontinue) please have MD (Medical Doctor) document brief explanation why this dose is appropriate for this resident. This was not addressed until 06/09/23 when the physician wrote-she can not sleep without Restoril 30mg HS (hour of sleep). A trial was done that only ended in disruption of her health. Pharmacy recommendation for May, 9 2023 revealed Consider gradual dose reduction of Restoril, Restoril 30mg HS since 02/02/23. If unable to reduce or DC please provide a brief explanation why reductions can not be attempted at this time. 2. Resident #16 was admitted to the facility on [DATE]. Diagnoses included Quadreplegia, Tracheostomy status, and Neuromuscular dysfunction of bladder. Resident #16's BIMS was 15 per quarterly MDS with an ARD on 06/25/23. A review of the consultant pharmacist recommendation for April 2023 revealed to consider a GDR (gradual dose reduction) for Lexapro 10mg QD (daily) since 07/14/18. If unable to reduce or DC please provide a brief explanation why reductions cannot be attempted at this time. The resident was still on this medication with no explanation as of the last date of the survey. An interview was conducted on 09/07/23 at 11:06 AM with Staff K, Quality Assurance. Staff K stated Resident #16 has not seen a Psychiatrist/Psychologist because the one they originally had for him was not a good fit. The physician is managing his Lexapro. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 13 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3. Resident #30 was admitted to the facility on [DATE]. Diagnoses included Unspecified convulsions, Paraplegia, and Unspecified coma. The resident is not able to do a BIMS. On March 6, 2023 the consultant pharmacist recommendation revealed the resident ordered Diastat (Diazepam) PRN without a stop date. If the medication should be continued past 14 days, please have the MD document the rationale of continuing the order, and provide a stop date. April 3, 2023 the consultant pharmacist recommendation revealed the resident ordered Diastat (Diazepam) PRN without a stop date. If the medication should be continued past 14 days, please have the MD document the rationale of continuing the order, and provide a stop date. This order was addressed on 08/18/23. In May and June 2023, the resident was hospitalized . On July 3, 2023 the consultant pharmacist recommended a stop date for a prn order for Nayzilam. August 7, 2023 the consultant pharmacist recommended a stop date for a prn order for Nayzilam. On 08/18/23 the facility put a 12 month order on Nayzilam. On 09/07/23 the pharmacy reviews and physician response was discussed with the DON. The DON stated he started taking this over in August which was when he started as DON. An interview was conducted with Staff L, Resident Care Manager on 09/07/23 at 11:16 AM. She stated in February it was the previous DON's responsibility to follow up with Pharmacy recommendation, and from March to July this task was given to her and this just was not her focus to do the pharmacy recommendations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 14 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure that an antipsychotic medication to treat specific conditions is documented in the clinical record. It failed to provide a clinically written reason for the refusal of a gradual dose reduction (GDR) for 1 of 5 sampled residents reviewed for unnecessary medication (Resident #15). The findings included: A review of the facility policy titled Tapering Medications, revised on 03/20, showed the following: Medications will be reviewed by pharmacy and attending physician/subspecialists monthly for consideration of gradual dosage reductions. Tapering a medication is to find an optimal dose or determine whether continued use of the medication benefits the resident. Reductions are titrated slowly unless clinically contraindicated with the goal of drug discontinuation. Dosages are then monitored regularly with consideration of adverse reactions while examining the resident's response and level of functioning. Resident #15 was admitted to the facility on [DATE] with diagnoses of Seizures and Epilepsy. An order was noted for Quetiapine (an antipsychotic medication) at 25 milligrams at bedtime for a decreased level of consciousness dated 08/26/22. A review of the Intensive Care doctor dated 12/23/2019 showed that Resident #15 suffered a gunshot wound to the right side of his head. Resident #15 was receiving Quetiapine 37.5 milligrams at bedtime. In this note, the doctor revealed that after discussing with neurology, he started him on Quetiapine and may increase the doses as an outpatient to see if that helps him. A review of the discharge summary from the hospital dated 08/26/22 showed that Resident #19 was receiving Quetiapine at 25 milligrams a day. In an interview conducted on 09/06/23 at 11:20 AM, the Director of Nursing was asked as to why Resident #15 was on Quetiapine (Seroquel). The Director of Nursing said that it is given to Resident #15 for his seizures. He further noted that many of the kids with seizures are given this medication to slow them down. A review of the pharmacy recommendations that were done on 06/03/23 to 06/05/23 for antipsychotic recommendations of Seroquel showed that the medication was given on 12/03/22. In this note, it was recommended to consider a gradual dose reduction or, if unable to do so, to write a brief explanation of why the reduction cannot be attempted at this time. The Physician addressed the recommendation from the Consultant Pharmacist on 06/07/23 that she disagreed with the GDR but did not give any reasoning. In an interview conducted on 09/06/23 at 12:05 PM with the Case Manager, she said that all pharmacy recommendations are given to her, and she puts them in the Physician's folder to review the next time she comes in. In a phone interview conducted on 09/06/23 at 12:15 PM, the Consultant Pharmacist stated that he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 15 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few comes once a month to conduct medication reviews on all residents. He then writes a note, prints it on a doctor's note, and gives it to the Case Manager, who then gives it to the doctor. He further said that Resident #15 is given Seroquel to wake him up and that it is a known use of the medication that has this effect. According to the pharmacist, any medication given at this facility should be monitored for side effects. When asked about the recommendations that he wrote on 06/03/23 for Seroquel, he said to speak to the Case Manager, who has the doctors' notes regarding the recommendations. In an interview conducted on 09/06/23 at 12:30 PM, the Nurse Practitioner stated that sometimes Quetiapine is given to residents who may exhibit some behaviors. She further said that Resident #15 used to bite his tongue when he came into the facility. She further said that she would review the chart and let the Surveyor know as to why Resident #15 was on this medication. In another interview conducted on 09/06/23 at 1:00 PM with the Nurse Practitioner, she said that Resident #15 came from a hospital with an admission order for Seroquel, which was given in the hospital. Many times, they will keep the residents on the orders that were given in the hospital. She was asked if Resident #15 was given the medication because he was exhibiting behaviors or if he had a psychiatrist evaluation, and she was not sure. In an interview conducted on 09/07/23 at 12:00 PM, the Nurse Practitioner stated that Resident #15 was on Quetiapine before, which was prescribed by the intensive care doctor in the hospital. She further said it was initially written for Quetiapine at 37.5 milligrams and later reduced to 25.0 milligrams. The Surveyor expressed concern that the medication was not reevaluated for use after Resident #15 was admitted to the facility and that the doctor should have written a reason for the refusal of the GDR. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 16 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observations and interviews, the facility failed to ensure that garbage was disposed of properly. The findings included: Residents Affected - Few In an observation conducted on 09/06/23 at 7:00 AM, the main dumpster outside the facility was noted to be uncovered with large bags of garbage on the bottom of the dumpster. The area around the dumpster was noted with debris and dirty gloves. In an interview conducted on 09/07/23 at 1:00 PM, the Administrator stated that everyone is responsible for taking out the garbage when needed. The city will come twice a week to empty the primary dumpster outside. The dumpster is supposed to be covered with a lid, and the fenced area around the dumpster is closed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 17 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record and policy review, the facility failed to follow physician orders for 1 of 5 residents reviewed for unnecessary medication (Resident #1). The findings included: The facility's policy titled Physicians' Medication Orders dated 04/2009, reviewed 02/10/19 and revised 05/21 revealed Medications shall be administered only upon the written order of a person duly licensed and authorized to prescribe such medication in this state. Resident #1 was admitted to the facility on [DATE]. Diagnoses included Dependence on Respirator, Arthrogryposis Multiplex Congenita and Epilepsy. Arthrogryposis Multiplex Congenita is a term used to describe a variety of conditions involving multiple joint contractures. On February 14, 2023 the consultant pharmacist made a recommendation under the category Administration error, Priority High. Resident has order to give Atenolol 25mg (milligrams) Q 24 HR PRN (every 24 hours as needed) for SBP (systolic blood pressure)>140 or HR(heart rate) >100; Hold for SBP <100 or HR <60. Med not charted as given on 01/07 for HR 105, 01/08 for HR 109, 01/11 for HR 102. Please review with applicable staff. On March 6, 2023 the consultant pharmacist made a recommendation under the category Administration error, Priority High. Resident has order to give Atenolol 25mg (milligrams) Q 24 HR PRN (every 24 hours as needed) for SBP (systolic blood pressure)>140 or HR(heart rate) >100; Hold for SBP <100 or HR <60. Med not charted as given on 02/15 for HR 111. On May 9 2023 the consultant pharmacist made a recommendation under the category Administration error, Priority High. Resident has order to give Atenolol 25mg (milligrams) Q 24 HR PRN (every 24 hours as needed) for SBP (systolic blood pressure)>140 or HR(heart rate) >100; Hold for SBP <100 or HR <60. Med not given on 04/16 for HR 110. On June 5, 2023 the consultant pharmacist made a recommendation under the category Administration error, Priority High. Resident has order to give Atenolol 25mg (milligrams) Q 24 HR PRN (every 24 hours as needed) for SBP (systolic blood pressure)>140 or HR(heart rate) >100; Hold for SBP <100 or HR <60. The med not given on 05/01 for HR of 102, 05/22 for HR of 108, 05/30 for HR of 119. On July 3, 2023 the consultant pharmacist made a recommendation under the category Administration error, Priority High. Resident has order to give Atenolol 25mg (milligrams) Q 24 HR PRN (every 24 hours as needed) for SBP (systolic blood pressure)>140 or HR(heart rate) >100; Hold for SBP <100 or HR <60. Med not given as charted on 06/05 for HR 118. On August 8, 2023 the consultant pharmacist made a recommendation under the category Administration error, Priority High. Resident has order to give Atenolol 25mg (milligrams) Q 24 HR PRN (every 24 hours as needed) for SBP (systolic blood pressure)>140 or HR(heart rate) >100; Hold for SBP <100 or HR <60. Med not charted as not given on 07/17 for BP 143/86. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 18 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete On 09/07/23 the pharmacy reviews and physician response was discussed with the DON. The DON stated he started taking this over in August which was when he started as DON. But this was addressed with the nurse who made the error on 07/18/23. An interview was conducted with Staff L, Resident Care Manager on 09/07/23 at 11:16 AM. She stated in February it was the previous DON's responsibility to follow up with Pharmacy recommendation, and from March to July this task was given to her and this just was not her focus to do the pharmacy recommendations. Event ID: Facility ID: 106110 If continuation sheet Page 19 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on interviews and record review, the facility needed to monitor the effectiveness of its performance improvement activities to ensure that improvements are sustained for 2 of 2 repeated deficiencies from prior surveys. The findings included: A review of the facility ' s Quality Improvement Plan for 2023 to 2024 showed the following: identify indicators that reflect the quality of care for residents when monitored. Identified from the review and established priorities. Monitor areas of concern and develop a plan of action as indicated. A plan of action is needed to reduce, modify, or resolve the concern and plan of action by repeated monitoring as needed. A review of the [NAME] report showed that the facility had multiple repeated deficiencies at F692 (Quality of Care) and F814 (Food and Nutrition) from previous surveys. In an interview conducted on 09/07/23 at 3:20 PM with the facility ' s new Administrator, she reported that before she came, they were doing QAPI and safety meetings combined. QAPI was not done monthly but on a quarterly basis. She decided to start a Performance Improvement Plan (PIP) on QAPI, concentrating on properly conducting QAPI with her staff. The Administrator said her first QAPI was done on August 9th, 2023, and the next one is expected next week. When asked about the importance of reviewing previous deficiencies, she said that this is how you can follow through to make sure that deficiencies are not repeated. There is a break in the process if the same tag or area of concern is repeated, and it is probably not monitored as it should. In an interview conducted on 09/07/23 at 3:50 PM, the Nurse Practitioner stated that the process in the previous QAPI meetings was to look at the prior year ' s citations and review the time frame they had set out for that issue. A review of the correction book from the last Recertification survey, which was conducted from 05/31/22 to 06/03/22, showed the following: for Tag F692, the facility completed audits for eight weeks regarding combing enteral and po diet orders as appropriate and was stopped on 07/18/22. Further review showed that from January 2023 to March 2023, the facility monitored weight compliance, which was shown in a graph, but no reports or models were attached to the graph. Another weight compliance graph noted trending weight compliance from April to June 2022, but no other reports or models were attached. For Tag F814, education was conducted from June 2022 to July 2022 on the following areas: Was the dumpster clean, was the dumpster ' s lid closed, and was the dumpster in good condition? Continued review of the QAPI meetings with the new Administrator; she could not provide additional data for the last four quarters on the trending and tracking of previously repeated deficiencies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 20 of 21 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 106110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Childrens Comprehensive Care Center Inc 200 SE 19th Avenue Pompano Beach, FL 33060 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on interviews and record reviews, the facility failed to ensure that the Quality Assurance Performance Improvement (QAPI) meetings were composed of the required committee members in their quarterly meetings. Residents Affected - Few The findings included: A review of the facility ' s Quality Improvement Plan for 2023 to 2024 showed the following: The quality improvement team meets monthly to address quality improvement activities and consists of the Administrator, Medical Director, Director of Medical Operations, Director of Nursing, Resident Care Manager, Risk Manager, Dietary Consultant, Pharmacy Consultant, and the Maintenance Director. A record review of the Quarterly QAPI/Safety Meeting, conducted on April 18, 2023 (3rd quarter), did not show that the facility ' s Administrator participated in the meeting. A record review of the Quarterly QAPI/Safety Meeting, conducted on January 25, 2023 (2nd quarter), did not show that the facility ' s Administrator participated in the meeting. In an interview conducted on 09/07/23 at 3:20 PM, the facility ' s Administrator stated that she only started working here in June of this year. Before she came, they were conducting QAPI and safety meetings combined. The QAPI meetings were not held monthly but quarterly. When asked who the last Administrator was before she came, she did not know. The Administrator said that the facility changed a few Administrators this last year but could not give specific details. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106110 If continuation sheet Page 21 of 21