Inspection·December 14, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/13/23 at 8:05 AM, Staff A, C.N.A. was seen sitting down with a resident for eating assistance during breakfast. On 12/13/23 at 11:27 AM, in an interview with the Director of Nursing, when asked, What is the facility's policy when staff are feeding the residents? Are they able to sit or stand while providing eating assistance? The Director of Nursing stated, Staff are to sit down while feeding the residents. Record review of Resident #173 revealed, medical diagnoses of diagnosis of dysphagia (difficulty in swallowing food or liquids) following cerebrovascular disease (stroke). Record review of Resident #173 revealed, a diet of no added salt, pureed texture, and regular/ thin consistency. Record review of Minimum Data Set, in quarterly dated 12/01/2023 revealed, in Section C: Cognitive Patterns, a brief interview of mental status was a five, which suggests severe cognitive impairment. In Section GG: Functional Limitation in Range of Motion, the Upper extremities has no impairments. In Section K: Swallowing/Nutritional Status, no to swallowing issues. In Section O: Special Treatments, Procedures, and Programs: No to speech therapy. Record review of the task for certified nursing assistants included, activities of daily living, extensive assistance times one for breakfast, lunch, and dinner as needed. Record review of the care plan, with a next review date of 2/29/2024 revealed, Resident #173 is on restorative program assistance with active range of motion to bilateral upper extremities three times a week, bed mobility three times a week, and activities for daily living (grooming hygiene, dressing upper body/ lower body). The interventions included, Assist with Set up/Feeding as needed and as tolerated. The goals included, Resident #173 will maintain the highest functional ability to all extremities and prevent contractures/further contractures. Review of the facility policies and procedures titled Promoting / Maintaining Resident Dignity during mealtimes. Issued 3/2020. The policy statement stated, it is the practice of this facility to treat each resident with respect and dignity and care for each resident in a manner and in an environment that maintains or enhances his or her quality of life, recognizing each resident's individuality and protecting the rights of each resident. Under the section titled, Policy Explanation and Compliance Guidelines part 5, All staff will be seated, if possible while feeding a resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to accurately code the Minimum Data Set (MDS) for one resident (R # 43) out of one sampled residents reviewed for death. Resident #43 expired in the facility and the MDS Section A for Identification Information, Discharge Status did document the resident was deceased . Residents Affected - Few The findings included: Record review of the clinical records for Resident # 43 revealed the resident was admitted to the facility on [DATE] and expired in the facility on [DATE]. Clinical diagnoses included, but were not limited to, Encounter for Palliative Care; Malignant Neoplasm of Colon, Unspecified; Secondary Malignant Neoplasm of Liver and Intrahepatic Bile Duct. Record review of the Significant Change MDS dated [DATE] revealed it was the last MDS completed for resident #43. The MDS Section A for Identification Information, Discharge Status did document the resident was deceased . Record review of Nurses Notes dated [DATE] revealed, the Certified Nursing Assistant called the nurse to resident's room. Upon arrival, the resident was unresponsive to verbal or tactile stimuli. Record review of Nurses Notes dated [DATE] revealed, resident #43 had a (Do Not Resuscitate (DNR) status). Interview with the MDS Coordinator on [DATE] at 10:37 AM revealed, she stated the resident expired in the facility. She stated, she forgot to add the resident was deceased . She stated she will make a correction to the MDS. Interview with MDS Coordinator on [DATE] at 10:45 AM revealed, the MDS Coordinator showed the surveyor the correction with a date of [DATE]. The MDS Section A, Identification Information dated [DATE] was corrected on [DATE] and documented the resident was deceased . Review of Policy and Procedures for Resident Assessments issued 03/2021 revealed Policy: It is the policy of the facility to adhere to the following procedures related to the proper documentation and utilization of a resident's Minimum Data Set (MDS) to ensure a comprehensive and accurate assessment of residents will be completed in the format and in accordance with time frames stipulated by the Department of Health and Human Services Center for Medicare and Medicaid Services. This assessment system will provide a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacities and assist to identify health problems for care plan development. Procedure: Completion of the Minimum Data Set: 5-Quarterly assessments are also done for residents every three months, at least every 92 days following a comprehensive assessment. Annual, entry, discharge and re-entry assessments are completed following the guidelines indicated in the Final Rule and the Resident Assessment Instrument (RAI) MDS Version 3.0 guidelines. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, observations and interviews, the facility failed to provide appropriate Services and care related to foley catheter positioning as per facility policy to prevent a potential Urinary Tract Infection (UTI) for one out (Resident #153) out of 11 residents residing in the facility who had indwelling urinary catheters. The findings included: During observation on 12/13/2023 at 08:40 AM, Certified Nursing Assistant (Staff I), pushed resident #153 in a shower chair in the hallway to his room. Resident #153 was covered with a towel; the catheter tubing was observed to be looped under resident #153 causing the collection bag to be above the level of resident's bladder. Registered Nurse (Staff G) was informed and immediately entered the room with the surveyor. Staff G was obsereved to place the collection bag below the level of the residents bladder into pocket of the shower chair. Staff G explained to Staff I that the collection bag should always be below the level of bladder. On 12/13/23 at 11:15AM, Resident #153 was observed seated in his wheelchair near the designated smoking area with his catheter tubing unkinked, the collection bag was below the level of the bladder was inside a dignity bag, and attached to his wheelchair. Record review revealed, Resident #153 was admitted on [DATE], and readmitted on [DATE] with diagnoses that includes Cerebral Infarction due to Unspecified Occlusion or Stenosis of Left Posterior Cerebral Artery. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed, Section C (Cognitive Status) Brief Interview for Mental Status score was 11 on a scale of 00-15, indicating no cognitive impairment. Section GG (Functional Abilities and Goals) no information in MDS. Section H (Bladder and Bowel) resident had an indwelling catheter. Section I (Active Diagnosis) Anemia, Heart Failure, Hypertension, Malnutrition, Diabetes, Depression. Section M (Skin conditions) no skin conditions present Review of December 2023 physician orders revealed, suprapubic urinary catheter care every shift and as needed, dated 9/7/2023, always anchor urinary catheter in place to prevent pulling, trauma/dislodgement. dated 11/21/23, maintain dignity bag over urine collection bag for privacy and below the level of the bladder every shift dated 12/7/2023, monitor suprapubic catheter every shift for leakage or blockage notify Medical Doctor (MD) dated 12/7/2023. Review of the Care Plan with the date initiated was December 24, 2022, and date revised December 19, 2023 revealed, A problem of Indwelling catheter and at risk for UTI's. Interventions: Place drainage bag into privacy bag for dignity at all times and below level of the bladder. Attach catheter to leg bag as needed. Attach catheter to bedside drainage and ensure closed drainage system intact. Change catheter, tubing and drainage bag as ordered. Monitor amount, character, color, odor of urine output and notify MD as indicated. Monitor every shift for urinary output, abdominal pain or distention. Observe for blood in urine and notify nurse/MD as indicated. Provide good perineal hygiene. Provide urinary catheter care Every (Q) shift and as needed (PRN). Work with MD for possible discontinue (DC) of catheter. During interview on December 13, 2023, at 10:31 AM, translated by Registered Nurse (Staff H), Staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 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 0690 Level of Harm - Minimal harm or potential for actual harm I reported, when taking care of residents with indwelling catheters, the collection bag should be below level of bladder and not touching the floor. Staff I reported, when a resident with an indwelling catheter is assisted with a shower, the collection bag is to be kept below the level of the bladder by placing it into the pocket on the side of the shower chair. Staff I stated, she did not place foley in the shower chair pocket below the level of the residents bladder because she was nervous. Residents Affected - Few Interview on 12/13/23 at 10:41AM, the DON stated an Inservice regarding indwelling catheters care is in progress. The DON reported the indwelling catheters collection bags are to be kept below the level of the bladder. The DON reported, the Certified Nursing Assistants are educated upon hire about indwelling catheter care. The DON reported, when a resident is being assisted with showering, the indwelling catheters collection bag is to be kept below the level of the bladder by tucking it into the pocket of the shower chair. Review of the facility's Policy and Procedure for Indwelling Catheter Use issued date: 6/2020 Revised: Standard: It is the Policy of the facility to ensure the appropriate use of indwelling urinary catheters in accordance with State and Federal Regulations and national guidelines. Procedure: Indwelling urinary catheters are to be used when indicated according to national guidelines such as those by the Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidelines (often referred to as the Centers for Disease Control and Prevention guidelines). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 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 0694 Provide for the safe, appropriate administration of IV fluids 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 review, the facility failed to follow the physician's orders for changing midline (intravenous catheter or IV line) dressing for one (Resident #485) out of 45 sampled residents as evidenced by a midline dressing dated over five days old. Residents Affected - Few The findings included: In an observation on 12/11/23 at 09:48 AM, Resident #435 was in bed with eyes closed with a nasal cannula at two liters per minute. In an observation on 12/12/23 at 09:12 AM, Resident #435 was resting in bed with eyes closed with a nasal cannula at two liters per minute. In an observation on 12/13/23 at 11:12 AM, Resident #435 was resting in bed with eyes closed. It was observed with Staff C, Registered Nurse (RN) that Resident #435's left arm had a midline IV catheter and the dressing was dated 12/08/2023 with no initials. (See photo evidence) Record review of the treatment administration record for December 2023 revealed, a physician order which stated to change midline catheter site dressing every 72 hours and as needed with transparent Dressing. The treatment recored revealed on 12/08/23 and 12/11/23 the dressing change was initialed as completed and the next midline dressing change due date was on 12/14/2023. On 12/13/23 at 11:17 AM, during an interview with Staff C, R.N. (Registered Nurse). It was asked, Were you Resident #435's nurse on 12/11/23 and was the dressing changed on that day? Staff C, R.N. stated, I was Resident #435 nurse on 12/11/23. I changed her dressing on 12/11/23, but I got the dates confused. I'll change her midline dressing now. On 12/13/23 at 11:31 AM, during an interview with the Director of Nursing. It was discussed that Resident #435's midline dressing was dated 12/08/23. It was charted in the treatment administration record that the midline dressing was changed on 12/08/2023 and 12/11/2023. The Director of Nursing stated, I spoke to Staff C, R.N., and he stated that he changed the dressing. He said he put the wrong date. He was confused with the date. It was a mistake. Record review of Resident #435's medical diagnoses included, subacute osteomyelitis of the left ankle and foot. Record review of physician orders for December 2023 revealed, midline catheter site dressing every 72 hours and as needed with transparent dressing with a start date of 12/5/2023. Ceftriaxone Sodium injection solution of one gram intravenously one time a day for osteomyelitis of left foot for 10 days with a start date of 12/5/2023. Record review of Minimum Data Set revealed, in Medicare five day assessment dated [DATE]. In Section C: Cognitive patterns, a brief interview of mental status was a six suggesting severe cognitive impairment. In Section M: Skin, does this resident have one or more unhealed pressure ulcers/injuries? Yes. Number of these unstageable pressure injuries that were present upon admission/entry or reentry? Two. Section N: Medications, antibiotics as a resident was a yes. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 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 0694 Level of Harm - Minimal harm or potential for actual harm Review of Resident #435's care plan revealed, the next review date was 3/3/2024. Resident #435 has a midline (intravenous line or IV line) to the left upper arm and is at risk for complications such as occlusion. Interventions were dressing changes to the site as per facility protocol. The date initiated was on 12/05/2023. The goal was Resident #435 would have no complications from intravenous therapy through the next review date. Residents Affected - Few Review of facility's policy and procedures for Peripheral Inserted Central Catheters. Issue date of 4/1/2022. The policy statement states, It will be the standard of this facility to adhere to IV (intravenous)/PICC line (Peripheral inserted central catheter) administration guidelines as set forth by infection control, state, and federal regulations. Licensed nurses shall provide care according to state and federal law. In section, procedures, 3. Dressing should be changed as per the physician's orders. In the section titled dressing changes, it stated at least weekly, and dressing changes will be documented in the clinical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, observations and interviews, the facility failed to ensure proper labeling and disposal of medications as evidenced by one eye drop and one insulin pen past expiration dates on one the East medication cart out of five carts reviewed and two bottles of liquid medication past the expiration date printed on the bottle, in the [NAME] Medication room out of four medication rooms reviewed in facility. This affected 4 out of 45 sampled residents (Resident #8, #11, #21, and #146). The findings included: On 12/13/23 at 02:41 PM, observation of the first floor East Medication cart contained one Brimonidine Sol 0.2% eye drop, with an open date of 10/25/2023 written on the bag for Resident#8 and an additional pharmacy label stuck onto the bag with a different resident's name and different medication name. This cart also contained one opened vial of Insulin Glargine sol 100U/mL(10mL) (Units/milliters) with an open date of 11/1/2023 for resident #21. (see photo evidence). On 12/13/23 at 03:00 PM, observation of the first-floor [NAME] Side Medication room contained two bottles in the medication refrigerator past the expiration dates. The first bottle was labeled Omeprazole 2mg/mL (milligrams/milliliters), had a written date of 11/2/23 on the front label, an expiration date of 11/15/2023 printed on the back label, for resident #146. The second bottle was labeled Omeprazole 2mg/mL, had a written date of 11/9/23 on the front label, an expiration date of 11/22/23 printed on the back label for resident #11. (see photo evidence) Review of medical records revealed, Resident#8 was admitted on [DATE] and readmitted on [DATE] with diagnoses to included Primary Open-Angle Glaucoma Bilateral Mild Stage. Further review of the Minimum Data Set (MDS) dated [DATE] Section C for Cognitive status revealed a Brief Interview for Mental Status (BIMS) score of 11 out of a scale of 00-15 indicating moderate impairment. Review of the physician orders revealed, Brimonidine Tartrate Ophthalmic Solution 0.2% Instill 1 drop into both eyes one time a day related to Primary Open-Angle Glaucoma Bilateral Mild Stage dated 10/25/23. Further review of the Electronic Medication Administration Record (EMAR) for 12/2023 revealed the medication is administered daily. Review of the medical records for Resident#21 admitted on [DATE] and readmitted on [DATE] with diagnoses that included Type 2 Diabetes Mellitus. Review of the quarterly MDS dated [DATE] Section C for Cognitive status revealed a BIMS score of 07 on a scale of 00-15 indicated severe cognitive impairment. Review of the physician orders revealed, Insulin Glargine 100 UNIT/ML Solution Inject 15 units Subcutaneous at bedtime. Further review of the EMAR for 12/2023 revealed, Insulin Glargine medication administered daily. Review of medical records revealed, Resident#146 was admitted on [DATE] with diagnoses that included Gastrostomy. Review of the Quarterly MDS dated [DATE] revealed, Section C for cognitive status revealed a BIMS score of 06 on a scale of 00-15 indicated severe cognitive impairment. Review of the physician orders revealed, Omeprazole Oral Suspension 2 MG/ML (Omeprazole) Give 20 ml via PEG-Tube one time a day related to Gastro-esophageal reflux disease (GERD) dated 1/31/23. Review of the EMAR for 12/2023 revealed, Omeprazole Oral Suspension administered daily. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Review of the medical records revealed, Resident#11 was admitted on [DATE] and readmitted on [DATE] with diagnoses that included Chronic Gastritis. Review of the Quarterly MDS dated [DATE] Section C cognitive status revealed a BIMS score of 06 out 00-15 indicated severe cognitive impairment. Review of the physician orders revealed Omeprazole 2MG/ML solution 10ML (20MG) Give 10 ml by mouth one time a day for GERD dated 11/9/23. EMAR for 12/2023 reviewed Omeprazole administered daily. Residents Affected - Few Interview on 12/13/23 at 02:50 PM with Registered Nurse (Staff D) it was stated, eye drops and insulin once opened are expired after 28 days, then must be discarded. Staff D stated, the Brimonidine eye drop, and Insulin Glargine in the East side medication cart are expired. Staff D stated, she will call the pharmacy and re-order the expired medications. Interview on 12/13/23 at 03:10 PM, Registered Nurse (Staff E) stated, the two liquids bottles of medication in the medication room refrigerator are expired. Staff E stated, when a bottle of medication is received from pharmacy the open date is written on the front of the medication. Staff E stated, the expiration date is located on the back of the bottle and the medication should not be used or stored in the refrigerator after it is expired. Staff E stated, she will reorder the medication and dispose of the expired medication with another nurse. Interview on 12/13/23 at 03:15 PM, the Director of Nurses (DON) stated medications should not be used or stored past the expiration date. The DON stated she will begin in-servicing the nursing staff regarding proper storage of medication. The DON stated, the expired medications will be reordered STAT (immediately) and received within 2 hours from the pharmacy. Interview on 12/14/23 at 11:27 AM, the Assistant Director of Nurses (ADON) stated the medication nurses monitor the medications in the cart daily and dispose of expired medications. The ADON stated, the supervisor follows up daily to ensure accuracy of medication storage. The ADON stated on Fridays each nurse cleans their cart. The ADON stated, that the pharmacy consultant comes in monthly and assesses the medication cart and medication with the nurse. The ADON stated there is a list of medication expiration dates kept in the Narcotic/Log/Resources book on each medication cart. The ADON stated medications cannot be used after the expiration date. The ADON stated nurses should reorder medication a week before medication is due to run out. Interview on 12/14/23 at 11:36 AM, Registered Nurse (Staff F) stated, she is the supervisor for the entire facility on the 7 AM to 7 PM shift. Staff F stated, each day the floor nurses inspect their carts and medication rooms and I check once a week. Staff F stated, if any medication is needed, I call the pharmacy. Staff F stated, when the medication is low or expired, I reorder. Staff F stated, Eye drops and Insulin are good for 30 days after opening. Staff F stated Medications cannot be used after the expiration date. Staff F stated, I reorder medications at least one week before the expiration date. Staff F stated, the pharmacy consultant comes to facility monthly and checks the medications with me and the nurse. Interview on 12/14/23 01:45 PM with a Pharmacy Consultant revealed, a consultant visits the facility monthly. The Pharmancy Consultant stated, if there are deficiencies found on the cart, the nurse is educated at that time. The Pharmancy Consultant stated, the Brimonidine Eye drops bottle is labeled with an expiration date. The Pharmacy Consultant stated, Insulin Glargine expires 28 days once opened. The Pharmacy Consultant stated, Omeprazole suspension expires 30 days after the dispense date. The Pharmancy Consultant stated, it is not advised to administer medications after expiration date. Review of Policy and Procedure entitled, Labeling of Medications Storage of Drugs and Biologicals (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few date implemented: 11/28/2019. Policy: It is the policy of this facility to ensure that all medications and biologicals used in the facility will be labeled and stored in accordance with current state, federal regulations. Purpose: The purpose of this procedure is to ensure the accurate labeling of all medications and biologicals to facilitate consideration of precautions and safe administration of medications. Policy Explanation and Compliance Guidelines: 1. All medications and biologicals will be labeled in accordance with applicable federal and state requirements and current accepted pharmaceutical principles and practices. 5. Labels for individual drug containers must include: h. the expiration date when applicable 9. Labels for multi-use vials must include: all opened or accessed vials should be discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for the opened vial. Review of document entitled, [ Consulting Services], Inc., Last Updated 7/12/2023, Expiration Dates for Open Injectable Diabetes Medication revealed, Insulin Glargine expires 28 days after opening. Review of undated document entitled, [ Consulting Services], Inc. Medications with Shortened Expiration Dates revealed Omeprazole Suspension expires 30 days once opened. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 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 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on observations, record review and interview, the facility failed to employ a Director of Food and Nutrition Services with required qualifications that includes two or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023. The findings included: Record review of the Job Description for the Dining Services Director/Account Manager documented: The Dining Services Director/Account Manager manages the dining services program and must hold state and/or federal required credential within no more than three months of placement in Dining Services Director/Account Manager position. Provides leadership, support and guidance to ensure that food quality standards, inventory levels, food safety guidelines and customer service expectations are met. Essential functions of the job is to: Supervises, coordinates and evaluates work of all dining services employees in preparing and serving food and cleaning facilities and utensils in a production kitchen; Conducts planning and budgeting; Forecasts and plans the purchase of food, supplies and equipment and ensures that established sanitation and safety standards are maintained. The Dining Services Director/Account Manager reports to the Dining Services District Manager. Review of the Job Description for the Registered Dietitian documented: Provides registered dietitian services in according to policies and procedures and federal/state requirements. The registered dietitian has administrative authority, responsibility and accountability necessary to carry out assigned duties. Responsibilities include planning, organizing, developing and directing the nutritional care of the resident in accordance with current federal, state and local standards, guidelines and regulations that govern the facility. Works effectively with others to ensure that quality nutritional services are being provided on a daily basis and acts as a resource to the Director of Dining Services so that the dining services department is maintained in a clean, safe and sanitary manner. Essential functions of the job is to: Completes comprehensive nutrition assessments and care plan development in accordance with federal and state regulatory guidance; Completes comprehensive assessments in accordance with current standards of practice and provides oversight and guidance to the Dining Services Director regarding dining services operations. The Registered Dietitian reports to the Director of Clinical Operations. On 12/11/23 at 8:03 AM, interview with the Accounts Manager/Food Service Director revealed that he is not a CDM (Certified Dietary Manager) and the RD (Registered Dietitian) does not oversee him or the kitchen. He has only been in the position of Food Service Director for a couple of months. On 12/11/23 at 8:05 AM, interview with the Corporate District Manager revealed that the Food Service Director is not a CDM and that the Dietitian does not oversee the Food Service Director nor the kitchen. On 12/12/23 at 8:25 AM, interview with the Registered Dietitian (RD). She stated, I am here in the afternoons. Monday and Fridays in the afternoons. They have me listed as fulltime with 32 hours. I don't oversee the kitchen nor the Food Service Director. On 12/12/23 at 9:27 AM, interview with the Human Resources Director. She stated, He (Accounts Manager/Food Service Director) was hired on 8/29/1999. He was a [NAME] at that time. On 10/13/2019 he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 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 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few became a Dietary Supervisor/Cook. He has a Dietetic Management and Supervision Certificate from [ ] a local technical college dated 12/23/2016. He had a [ ] sanitation certification dated 5/27/2016 and it expired on 5/27/2021. He received Food Safety Manager Training on food safety certificate of completion on 10/26/2023. He is now an employee of the [ ], a contracted company. On 12/12/23 at 9:32 AM, interview with the Corporate District Manager. He stated, I am his direct supervisor. I manage separate buildings. I try to come in once a week and sometimes twice a week. I'm in the process of trying to see if he qualifies to take the CDM exam. On 12/13/23 at 8:39 AM, interview with the Administrator. He stated, We signed the contract with [ ], the contracted food services group on 9/24/22 and we first started with them on October of that year. The Dining Services Director/Account Manager is qualified for the position because he went to school, he has taken the classes. He is pending taking the test. The dietitian is qualified for the position because we have a full time dietitian. She oversees the kitchen. We have two CDMs who are contracted to come in and go in the kitchen. They are not full time, only part time. On 12/13/23 at 8:43 AM, interview with the RD. She stated, I am here Monday thru Friday doing nutritional assessments and I also go in the kitchen if I am needed. Review of the Dining Service Agreement contract revealed it was completed on September 21, 2022 with the [ ] contracted food services group. Review of the contracted dietary workers and the Account Manager was listed as hire date 9/30/2022. On 12/13/23 at 11:14 AM, interview with the contracted CDM. She stated, I come here two times a week and as needed in the kitchen. I am contracted as an LLC (limited liability company) but I am a CDM. I look at the sanitation for the kitchen. I let them know what I find and they deal with their employees. On 12/13/23 at 11:21 AM, interview with the Human Resources Director. She stated, The dietitian is contracted with [ ] contracted food services group. They have a separate payroll. On 12/13/23 at 11:23 AM, interview with the Corporate District Manager. He stated, The RD is under our company. Two months of the RD timesheet were requested to verify hours worked. Subsequent interview with the Corporate District Manager on 12/13/23 at 12:03 PM. He stated, The Dietitian is not designated as the Director of Food Service. On 12/14/23 at 6:52 AM, interview with the Accounts Manager/Food Service Director. He stated, I see the Dietitian at least four times a week. I do the budget for the kitchen. On 12/14/23 at 6:54 AM, interview with Staff I, Dietary Aide. She stated, Sometimes the dietitian is here twice a week. On 12/14/23 at 6:56 AM, interview with Staff J, Dietary Aide. She stated, I see her (the dietitian) everyday. On 12/14/23 at 6:57 AM, interview with Staff K, Dietary Aide. She stated, I see her (the dietitian) four days in the kitchen. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 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 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the time sheets dated September 29, 2023 to December 1, 2023 for the RD documented she punched in and out mostly everyday for 6 hours or more. Review of the QAPI (Quality Assurance Performance Improvement) Meeting Minutes for August 2023, September 2023 and October 2023 documented the registered dietitian was not present at the meetings. The diet technician was present at the meetings. Review of the Facility Assessment, updated 12/13/23, date reviewed with QAPI Committee 12/21/23 documented: 1) The Dietitian and Food Service Director were involved in completing the facility assessment; 2) Staff Type: Food and Nutrition Services (Director, Support staff, Registered Dietitian); 3) Dietitian or other clinically qualified nutrition professional to serve as the Director of Food and Nutrition Services Range (FTEs)-2 and Food and Nutrition Services Staff Range (FTEs) 14-15 daily. there were 14 Dietary staff and the Nutrition department provided individualized dietary requirements, specialized diets, IV nutrition, tube feeding, cultural or ethnic dietary needs. The Facility Assessment was received on 12/11/23. On 12/14/23 at 11:30 AM, interview with the RD. She stated, I do not attend the QAPI meetings because I come in the afternoons. I usually come in around 2:30 to 3:00 PM. The Registered Diet Tech attends the QAPI meetings and the care plan meetings. My title is a Clinical Dietitian. I am not designated as the Director of Food Service. Review of the Federal requirements for a qualified Dietitian functioning at a minimum include: Assessing the nutritional needs of residents; Developing and evaluating regular and therapeutic diets, including texture of foods and liquids, to meet the specialized needs of residents; Developing and implementing person-centered education programs involving food and nutrition services for all facility staff; Overseeing the budget and purchasing of food and supplies, and food preparation, service and storage and participating in the quality assurance program, when food and nutrition services are involved. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews and record review, the facility failed to 1) store food under sanitary condition by ensuring the proper temperatures in the reach-in cooler and 2) ensure the reach-in cooler was working properly. This has the potential to affect 169 out of 182 residents who eat orally residing in the facility at the time of the survey. The findings included: Record review of the Refrigerator/Freezer/Dishwasher Logs Policy and Procedure (Issued 9/2018); Policy Statement-The temperatures of the refrigerators and freezers will be recorded twice a day; Procedure-1b) Refrigerators shall be 35-40 degrees Fahrenheit. Observation during the initial kitchen tour on 12/11/23 at 8:16 AM with the Accounts Manager/Food Service Director and the Corporate District Manager revealed, the reach-in cooler temperature was 60 degrees F (Fahrenheit) on the outside and 60 degrees F on the inside. The reach-in cooler contained apple sauce. Observation of the lunch tray line on 12/13/23 at 11:02 AM revealed, food temperatures were being taken and conducted by the Accounts Manager/Food Service Director. The dessert was Gelatin Cubes and the temperature was 52 degrees F. The desserts were contained in a long pan with ice and was removed from the reach-in cooler. Second observation of the reach-in cooler on 12/13/23 at 11:03 AM revealed, 50 degrees F on the outside and 60 degrees F on in the inside. The reach-in cooler contained desserts and juices. On 12/13/23 at 11:04 AM, interview with the Accounts Manager/Food Service Director. He stated, The temperature on the refrigerator should be 41 degrees. Observation of the reach-in cooler on 12/13/23 at 11:05 AM revealed, all desserts and juices were removed from the reach-in cooler by the dietary staff. Record review of the reach-in cooler Temperature Log for December 2023 documented the following: 12/11/23 5:30 AM Temperature was 40 degrees F and on 12/13/23 5:00 AM Temperature was 40 degrees F. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 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 observations, interview and record review, the facility failed to demonstrate effective plan of actions were implemented to correct identified quality deficiencies in the problem area related to repeated deficient practices for F550 Resident Rights/Exercise of Rights related to the facility failed to ensure that residents had a dignified existence for Resident # 173 of three residents reviewed for dignity and failed to maintain dignity during dining and F812 Food Procurement Store/Prepare/Serve/Sanitary as evidenced by facility failed to 1) store food under sanitary condition by ensuring the proper temperatures in the reach-in cooler and 2) ensure the reach-in cooler was working properly. This deficiency had the potential to affect 182 residents residing in the facility at the time of survey. The findings included: Record review of the facility's survey history revealed, during a recertification survey with exit dated October 12, 2022. F550 Resident Rights/Exercise of Rights was cited related to the facility failed to ensure that residents had a dignified existence for 2 (Resident # 124 and Resident # 21) of 4 residents reviewed for dignity and failed to maintain dignity during dining for 1 (Resident #15) of 4 residents reviewed for dignity and F812 Food Procurement Store/Prepare/Serve/Sanitary as evidenced that the facility failed to store, prepare, serve food in accordance with professional standards for food service safety. The issues included: failure to protect food from contamination, failure to maintain sanitizing chemical solutions, failure to maintain refrigeration and ice machines, and proper cleaning and maintenance of food preparation equipment. Interview with Administrator and Director of Nursing on 12/14/23 at 12:57 PM. They stated that the QAPI (Quality Assurance and Performance Improvement) meeting is held on the third or fourth week of every month. They stated QAPI Committee included the Administrator, Director of Nursing, Medical Director, Social Services Director, Dietary Director, Infection Preventions, Medical Records Director, Nurse supervisors, the Maintenance Director, Environmental Director, Minimum Data Set (MDS) Coordinator and a Certified Nursing Assistant is invited. They stated they have morning meetings; staff reveal the issues from the prior day. They stated if the issue is high risk for residents, it is addressed immediately. The administrator stated last month's meetings were discussed and they were working to prevent falls and it worked, the resident's fall incidents decreased in comparison to last year. The Director of Nursing stated that the Quality Assessment and Assurance (QAA) committee knows when an issue arises because every department brings its own reports and discusses each area. She stated the CASPER report and trends are used to know what is occurring in the facility. The Administrator stated staff received in-service education to prevent abuse/neglect, how to prevent falls, how to prevent pressure injuries for the residents with risk for injuries, and etc. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 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 106128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Miami Springs Nursing and Rehabilitation Center 201 Curtiss Pkwy Miami Springs, FL 33166 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews and record review, the facility failed to ensure the reach-in cooler was working properly. This has the potential to affect 169 out of 182 residents who eat orally residing in the facility at the time of the survey. Residents Affected - Few The findings included: Record review of the Refrigerator/Freezer/Dishwasher Logs Policy and Procedure (Issued 9/2018); Policy Statement-The temperatures of the refrigerators and freezers will be recorded twice a day; Procedure-1b) Refrigerators shall be 35-40 degrees Fahrenheit. Observation during the initial kitchen tour on 12/11/23 at 8:16 AM with the Accounts Manager/Food Service Director and the Corporate District Manager revealed, the reach-in cooler temperature was 60 degrees F (Fahrenheit) on the outside and 60 degrees F on the inside. The reach-in cooler contained apple sauce. Observation of the lunch tray line on 12/13/23 at 11:02 AM revealed, food temperatures were being taken and conducted by the Accounts Manager/Food Service Director. The dessert was Gelatin Cubes and the temperature was 52 degrees F. The desserts were contained in a long pan with ice and was removed from the reach-in cooler. Second observation of the reach-in cooler on 12/13/23 at 11:03 AM revealed, 50 degrees F on the outside and 60 degrees F on in the inside. The reach-in cooler contained desserts and juices. On 12/13/23 at 11:04 AM, interview with the Accounts Manager/Food Service Director. He stated, The temperature on the refrigerator should be 41 degrees. Observation of the reach-in cooler on 12/13/23 at 11:05 AM revealed, all desserts and juices were removed from the reach-in cooler. Record review of the reach-in cooler Temperature Log for December 2023 documented the following: 12/11/23 5:30 AM Temperature was 40 degrees F and on 12/13/23 5:00 AM Temperature was 40 degrees F. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106128 If continuation sheet Page 16 of 16