Inspection·December 7, 2023

F 0580 would first contact the POA to notify of any changes in the resident's plan of care. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 2 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to follow their grievance policy related to: 1) Medication concerns for 1 of 29 sampled residents (Resident #28); and 2) Food concerns for 17 out of 29 sampled residents (Resident #21, #289, #287, #31, #4, #67, #285, #59, #292, #186, #290, #69, #291, #294, #44, #15, and #11). The findings included: The facility's Grievances/Complaint, Filing Policy (2001 Med-Pass, Inc., Revised April 2017) states: Residents and their representatives have the right to file grievances, either orally or in writing, to the facility staff or to the agency designated to hear grievances (e.g. the State Ombudsman). The Administrator and staff will make prompt efforts to resolve grievances to the satisfaction of the resident and/or representative. Policy Interpretation and Implementation 3. All grievances, complaints or recommendations stemming from resident or family groups concerning issues of resident care in the facility will be considered. Actions on such issues will be responded to in writing, including a rationale for the response. 8. Upon receipt of a grievance and/or complaint, the Grievance Officer will review and investigate the allegations and submit a written report of such findings to the Administrator within five (5) working days of receiving the grievance and/or complaint. 11. The Administrator will review the findings with Grievance Officer to determine what corrective actions, if any, need to be taken. 12. The resident, or person, filing the grievance and/or complaint on behalf of the resident, will be informed (verbally and in writing) of the findings of the investigation and the actions that will be taken to correct any identified problems. a. The Administrator, or his or her designee, will make such reports orally within [blank] working days of the filing of the grievance or complaint with the facility. b. A written summary of the investigation will also be provided to the resident, and a copy will be filed in the business office. 1) On 12/06/23 at 11:49 AM, an interview was conducted with the Daughter and Power of Attorney (POA) of Resident #28 who stated, I have complained numerous times about not being notified regarding changes in my mom's medications, and about the timing of my mom's Levothyroxine and Omeprazole administration. I found out a few months ago that my mother's antidepressant medication was discontinued without anyone notifying me or discussing this change. Also, my mom's Levothyroxine and Omeprazole are not to be given together at the same time, and they are not to be given with food; yet I find that, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 3 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some once again, the nurses are giving these medications together with all the other medications. I specifically had my mom's doctor write the prescription indicating the times she is to be given these medications, but the order seems to have been changed. I have repeatedly informed nurses about these issues. The other day I went in and my mother's medications were still in her mouth. They don't seem to be making sure my mother swallows her pills. I have spoken to nurses and I have sent emails to the Administrator, but have received no response. None of these concerns are being resolved. Resident #28's POA stated she has never received anything in writing acknowledging her grievances, outcomes of investigations, or detailing the actions taken to correct the problem. A review of the grievance log shows no grievances listed for Resident #28 or her POA, even though the daughter confirms that she has voiced her grievances to nursing staff several times, and sent email to the Administrator. 2a) On 12/04/23 at 3:18 PM, Resident #4 stated, The food is never hot, and we are always missing something from the menu. Also, I think the portion sizes are very small. Today, we had turkey, but there was barely 2 oz of turkey on the plate. No gravy was provided for the mashed potatoes, and there was no cranberry sauce and no peach pie given, even though it states on the menu that it was to be included. Also, the food just doesn't taste good most of the time. These issues have been brought up during council meetings over and over again, but it still is not resolved. On 12/07/23 at 12:30 PM, the lunch meal served to residents eating in dining room on the 3rd floor was noted to be meatloaf with a small amount of gravy, plain white rice, and peas and carrots. There was no extra gravy provided for the rice. Those who requested gravy on the side, had approximately 1/8 of a cup of gravy served in separate container on the plate. The food served at this time was at a palatable temperature, per the interviewable residents. 2b) On 12/04/23 at 11:20 AM, Resident #67, whose BIMS [Brief Interview for Mental Status] is a 15 out of 15, stated, The facility does not always provide the meal I choose. I like to eat healthy, and on my meal ticket, I often choose the fruit and yogurt plate. Sometimes, I will be given something that I didn't order. The other day I got ravioli. The food they gave me tasted good, but it was not what I ordered. Review of Resident #67's Food Preferences completed on admission on [DATE] documents: Resident prefers to eat Low carb/Low fat diet and sugar-free beverages. 2c) On 12/04/23 at 11:18 AM, Resident #186 stated, The food portions are very small. I am often still hungry after eating. Also, the meals they deliver are often not what is listed on the menu for that day. The resident confirmed that he did voice his concerns to the care staff who delivered his food. Resident #186's BIMS was assessed on 12/01/23 as being a 15 of 15. 2o) Resident #69 was admitted to the facility on [DATE]. The resident has diagnosis to include Chronic Didney Disease Stage 4 (severe), dependent on Renal Dialysis, Muscle Wasting and Atrophy, Leukemia, Cardiac Implants and Grafts. On 10/30/23, a Quarterly evaluation was completed on Resident #69, and he was given a BIMS score of 15. A BIMS score of 15 indicates the resident is cognitively intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 4 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0585 Level of Harm - Minimal harm or potential for actual harm On 12/05/23 at 8:59 AM Resident # 69 was interviewed. He was asked about the food he receives at the facility. The resident is on a renal diet, regular texture, and thin consistency. The resident stated he received bacon and pancakes for breakfast. He stated this happens a lot lately where I don't receive what I am supposed to receive for breakfast. He then stated, I am to receive 4 hard-boiled eggs every day for breakfast. Residents Affected - Some On 12/06/23 at 8:47 AM Resident #69 was observed sitting up in his wheelchair at his bedside. He was waiting for his breakfast meal to arrive. He stated he always requests 4 hard-boiled eggs for breakfast and no muffins. The breakfast tray arrived, and he had 2 boiled eggs and a biscuit and some gravy. The diet slip for his meal listed his diet as regular consistent carbohydrate, no added salt renal, thin. The breakfast tray ticket documented the resident is to receive 4 boiled eggs daily. The resident was asked if he receives boiled eggs for any other meals and he stated he never receives any other boiled eggs throughout the day. He stated no, sometimes they will send those military powdered eggs. He stated then I am unable to separate the eggs. I like to just eat the white part of the egg. During an observation on 12/07/23 8:34 AM Resident #69 received a breakfast tray with scrambled eggs and bacon. The diet ticket was reviewed and documented 4 hard-boiled eggs daily. On 11/28/23 a grievance was filed for Resident #69 by his son concerning the resident wanting his hard-boiled eggs for breakfast. The grievance stated the resident wanted to speak to the dietician but could not reach them. The facility told the resident the dietician would be in on the 11/29 and would send them up to speak to the resident. The dietician spoke to the resident and reviewed his concerns. On 12/07/23 the grievance was reviewed with the Regional Nurse which stated the grievance was related to the resident wanting hard boiled eggs for breakfast. On 12/07/23 at 12:10 PM an interview was conducted with the Registered Dietician who stated the grievance which was filed on 11/28/23 was about Resident #69 receiving 4 hard-boiled eggs for breakfast. He stated he spoke with the resident concerning receiving hard-boiled eggs for breakfast. He was asked about the process when a resident request something for their diet. He stated, when he speaks to the residents, he writes it on the recommendation sheet which then goes to the Dietary Manager who places it on the tray card. The Dietician was informed that for the past few days Resident #69 had not received 4 hard-boiled eggs and it is written on his tray card for him to receive the hard-boiled eggs. He stated he would speak to Resident #69. 2p) The facilities Resident Council meeting minutes were reviewed for the past 6 months. Documented in the resident council meeting dated 10/05/23, the residents reported the breakfast trays are not delivered on a timely consistent basis. They stated the breakfast trays arrive anytime between 8:00 AM and 9:30 AM. They also reported they never receive any condiments such as butter, sugar, and salt. No grievances documented for the complaints mentioned in the 10/05/23 resident council meeting. Review of the Resident Council meeting on 10/19/23 did not indicate the previous concerns from 10/05/23 meeting was addressed. At the 10/19/23 Resident Council meeting the residents spoke about the quality of the food and the inconsistent times the meals arrived. They also stated the Always Available Menu was not always available. No grievance was found for the complaints mentioned in the 10/19/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 5 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Recorded in the minutes of the 11/02/23 the meeting minutes indicate the items from the previous resident council meeting were resolved. Record review revealed on 11/16/23 Resident #4 filed a grievance. Resident #4 has a BIMS score of 14 which indicates she is cognitively intact. The grievance which was filed had concerns which indicated the food was brought out late and she was not satisfied with the selection of the food and the vegetables being overcooked. The resolution to this grievance was to notify the kitchen of the overcooked vegetable. Record review revealed on 11/16/23 Resident #15 filed a grievance. Resident #15 has a BIMS score of 13 which indicated she is cognitively intact. She stated she does not like the food. The response to her grievance was to review the always available menu. On 12/06/23 at 2:53 PM a meeting was held with Resident #4, #11, #15 and #44. The residents were asked about the food at the facility. The residents all groaned at the same time. They stated they always bring up food issues at the Resident Council Meetings and nothing is ever done. They all stated the food is awful. They said the facility has never addressed it with them to their satisfaction. They stated breakfast is always lukewarm. Residents # 4 and #15 both stated they receive rice a lot and they don't like rice. It's just plain rice and it is dry. They never receive any condiments such as sugar, creamer, and butter. Resident #4 stated the food is always frozen we never get anything fresh. We never know what time the food is going to be served. On 12/06/23 at 10:00 AM, the Acting Dietary Manager stated, Previous Dietary Director has recently resigned. I started helping out the facility the beginning of this week .I cannot speak to what the previous Director did or did not do. It is the policy of the facility to immediately address whatever grievances are brought to our attention. On 12/07/23 at 12:00 PM, the Administrator stated that there is communication between dietary staff, administration, and the residents regarding food complaints/concerns. The Administrator was asked to provide documentation showing the details on how the facility is resolving the residents' food grievances. The only documentation provided in response to this request was an in-service provided to kitchen staff on 09/27/23 in response to Resident Council Follow up. On 12/07/23 at 12:28 PM, a meeting was held with the Administrator who is also the Risk Manager at the facility. The Administrator was asked about grievances. He stated that most of the grievances are generated from the resident council and food committee meetings. He was asked how he knows if corrective actions are working, He stated audits are done and they have daily meetings. He stated they have been addressing food and quality and in 11/23 reported the residents were happy with temperature and times and always available menu. The Surveyor stated the survey team did not find any concrete evidence about the quality of the food being addressed with individual residents and their issues were being addressed. The survey team was unable to locate any detailed evidence that individual residents' food concerns are being addressed to their satisfaction. The Administrator was informed the residents at the facility are not happy with the food and they expressed their unhappiness to the survey team. 2d) Record review revealed Resident #285 was admitted to the facility 11/17/23. The admission Minimum Data Set (MDS) assessment, reference date 11/24/23, recorded a BIMS score of 15, indicating Resident #285 is cognitively intact. The comprehensive care plan which was initiated on 11/20/23, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 6 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0585 Level of Harm - Minimal harm or potential for actual harm recorded Resident #285 was at risk for alteration in nutrition/hydration, related to abnormal lab values. Interventions included: to Provide, serve diet as ordered. On 12/04/23 at 9:38 AM, during interview with Resident #285, she stated the meals are always served cold, she never gets salt and pepper with her meals. Residents Affected - Some 2e) Record review revealed Resident #31 was admitted to the facility on [DATE] with diagnosis included: cancer. The admission MDS assessment reference date 10/06/23 recorded a BIMS score of 15, indicated Resident #31 is cognitively intact. This MDS recorded no mood/behavior issue for Resident #31. On 12/04/23 at 9:44 AM, an interview was conducted with Resident #31, he stated the facility food is not good, it was not edible. During that time, an observation was made of the breakfast tray, and the food was noted untouched. The resident voiced he couldn't eat the food. 2f) Record review revealed Resident #287 was admitted to the facility on [DATE]. The admission MDS assessment reference date 12/05/23 (which was in progress), recorded a BIMS score of 15, indicated Resident #287 was cognitively intact. On 12/04/23 at 10:02 AM, an interview was held with Resident #287, he complained about the food, he stated the food is always served cold. 2g) Record review revealed that Resident #21 was initially admitted to the facility on [DATE], re-admitted on [DATE] with diagnoses including: Thyroid Disorder and Malnutrition. The admission MDS assessment, reference date 11/03/23, recorded a BIMS score of 15, indicating Resident #21 is cognitively intact. This MDS recorded no mood/behavior issue. On 12/04/23 at 10:06 AM during an interview with Resident #21, she stated, the facility's food is horrible, her brother brings her food from outside. 2h) Record review revealed Resident #59 was initially admitted on [DATE] and re-admitted on [DATE] with diagnoses including non-Alzheimer's Dementia, and Malnutrition. The quarterly MDS assessment reference date 10/16/23 recorded a BIMS score of 07, indicating Resident #59 is moderately cognitively impaired. This MDS recorded no mood/behavior issue. On 12/04/23 at 10:38 AM during an interview process with Resident #59, she was observed alert and oriented, and coherent, she stated The facility's food tasted awful, I can't tolerate it. 2j) Record review revealed Resident #289 was admitted to the facility on [DATE], the admission MDS assessment reference date 11/29/23 (which was in progress) recorded a BIMS score of 15, indicating Resident #289 is cognitively intact. Review of the comprehensive care plan which was initiated on 11/24/23 recorded Resident #289 was at risk for alteration in nutrition/hydration related to sepsis (the body's extreme reaction to an infection). Intervention included: Provide, serve diet as ordered. On 12/04/23 at 11:06 AM, an interview was held with Resident #289, she stated the facility's food is no good, it is flavorless, she doesn't like it, and her sister brings her outside food to eat. 2k) Record review revealed Resident #290 was admitted to the facility on [DATE]. The admission MDS assessment reference date 11/28/23 (which was in progress) recorded a BIMS score of 15, indicating resident #290 is cognitively intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 7 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 12/04/23 at 11:11 AM, an interview was held with Resident #290, she stated The food is always served cold; and they serve rice every day. She stated she told the guy in the kitchen about it 2l) Record review revealed Resident #291 was admitted to the facility on [DATE] with diagnoses included: medically complex conditions, and Malnutrition. The admission MDS assessment reference date 11/29/23 (which was in progress), recorded a BIMS score of 15, indicaing Resident #291 is cognitively intact. This MDS recorded no mood/behavior issue. The comprehensive care plan initiated 11/27/23 recorded Resident #291 had a stage 4 pressure ulcer to the sacrum. Interventions included: Nutritional approaches to maintain optimal wound healing/skin integrity. On 12/04/23 at 11:22 AM, an interview was held with Resident #291, he stated no coffee is provided to him this morning, the facility's food was absolutely terrible, his family brings in outside food every day, and he would not eat the food at the facility. 2m) Record review revealed Resident #292 was admitted to the facility on [DATE] with diagnoses including: Thyroid Disorder and Diabetes. The admission MDS assessment reference date 11/27/23, recorded a BIMS score of 13, indicating Resident #292 is cognitively intact. This MDS recorded no mood/behavior issue. Review of the comprehensive care plan initiated 11/22/23 indicated Resident #292 was at risk for alteration in nutrition/hydration related to Type 2 Diabetes, Hypothyroidism, and Abnormal Nutritional Labs. Intervention included: Provide, serve diet as ordered. On 12/04/23 at 11:47 AM, an interview was held with Resident #292, she stated the food is not very tasty, it's usually not hot when served. 2n) Record review revealed Resident #294 was admitted to the facility on [DATE]. The admission MDS assessment reference date 12/04/23 (which was in progress), recorded a BIMS score of 8, indicaing Resident #294 is moderately cognitively impaired. On 12/04/23 at 11:57 AM, an interview process started with Resident #294, he was noted alert, oriented, and coherent, but slow to respond. During the interview, Resident #292 stated breakfast is always delivered late, never on time, and always served cold. During the interview, Resident #294's Personal Aide was in the room (the aide was from an agency staffing, the aide revealed she worked every day 12 hours a day with Resident #294). The personal aide stated, the facility took a long time to provide food, it is always late. On 12/06/23 beginning at 12:57 PM to 1:15 PM, an interview process started with the facility's Registered Dietitian; he was made aware of all the residents food concerns. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 8 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the Facility failed to ensure the Power of Attorney for 1 of 11 sampled residents' was notified of and included in the Resident's Care Plan Meetings (Resident #28). The findings included: Per Residents Rights [42 CFR 483.10], the facility must treat the decisions of a resident representative as the decisions of the resident to the extent required by the court or delegated by the resident, in accordance with applicable law. The resident has the right to be informed of, and participate in, his or her treatment, including: The right to be informed, in advance, of changes to the plan of care. Resident #28 was admitted to the facility on [DATE] with diagnoses which included Alzheimer's, Major Depressive Disorder, and Dementia. According to Minimum Data Set assessment completed on 09/29/23, Resident #28 had a Brief Interview for Mental Status (BIMS) score of 4 out of 15, indicating severe cognitive impairment. Because of Resident #28's cognitive issues, she was not able to make decisions for herself; therefore, the resident's daughter was designated as her POA to handle all of Resident #28's financial and health care decisions. On 12/05/23 at 12:22 PM, during interview with Resident #28's daughter and POA, she stated, I am the POA, and I have not been invited to any care plan meetings other than when my mom was first admitted . The previous Administrator and Social Worker refused to accept the fact that I was my mom's POA and refused to involve me in my mom's care. A review of Resident #28's Care Plan Meeting Notes reveal the following: 04/04/23 - Plan of care coordinated with IDT (Interdisciplinary Team), resident's MD (Medical Doctor) and direct staff. SS (Social Service) left resident's husband message regarding care plan meeting due to no answer. [ *It was noted that there was no call was placed to POA notifying her of Care Plan Meeting]. 10/02/23 - Quarterly care plan meeting via phone w/ pt's (patient's) daughter. She has no concerns at this time is involved in resident care. 10/03/23 - Had care plan follow up conversation w/ pt's daughter [Daughter's name]. She was able to provide some history for me, & was updated on her mom's status. She is aware of her Mom's right eye being reddened, as she had taken her to the eye appointment, & she had an injection. [Resident #28] has also been prescribed an antibiotic for lab results/+ UA. [Daughter] states she provides water, & juice boxes in the residents room, & would like staff to offer them to her mom. A review of the Care Plan Documentation shows: 01/02/23 - Telephone call made to POA inviting her to care plan meeting to be held on 01/05/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 9 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0657 01/05/23 - Care Plan meeting notes shows Resident's daughter in attendance at initial care plan meeting. Level of Harm - Minimal harm or potential for actual harm 04/04/23 - Care Plan meeting notes shows Resident's daughter was not in attendance. A note was handwritten on Care Plan meeting document stating that a message was left by Social Services for spouse. No documentation that POA/daughter was contacted. Residents Affected - Few 04/04/23 - Care Plan invitation dated 04/03/23 at 2:45 PM documents spouse was called and a message was left. No documentation that the POA/daughter was contacted. 07/19/23 - Document for Care Plan meeting held on 07/06/23 shows daughter was not in attendance. 06/24/23 - Care Plan invitation documents that a call was placed to spouse and message was left. No contact was made with the POA/daughter notifying her of the Care Plan meeting. No follow-up calls to spouse notifying him of meeting on 07/06/23. There was no Care Plan Meeting Signature Sheet or Invitation documentation found for the October Care Plan Meeting other than Care Plan note found in Progress Notes that documents Quarterly care plan meeting via phone w/ pt's daughter On 12/06/23 at 9:31 AM, an interview was held with Social Worker. He stated, I started this position on October 09, 2023, so I am not aware of any previous concerns with [Resident #28] .The procedure for Care Plan invitations and notifications is that we first check Resident's BIMS [Brief Interview for Mental Status]. If the resident is alert and oriented, I will ask them who they would like to be involved in the Care Plan meeting. If the Resident is not alert and oriented, then I will contact the Resident's Representative from the list on file. We would contact the POA and notify them of the meeting and ask them who else they would like to be involved in the care planning process. The Care Plan meeting forms are uploaded in the electronic records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 10 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide wound care dressing changes for 1 of 2 sampled residents reviewed for wound care, Resident #33. Residents Affected - Few The findings included: The facility policy, titled, Steps for Clean Dressing Change, and undated, documented, in part: addresses step by step how to perform a dressing change. The final step is 19 which reads, 'document in chart as needed.' Resident #33 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include: Type 2 Diabetes Mellitus with Diabetic Neuropathy, Charcot's joint left ankle and foot, Peripheral Vascular Disease, Ankylosis left ankle, Hypertensive Heart Disease, Major Depressive Disorder, presence of other orthopedic joint implants and Cardiac Pacemaker. Review of the Minimum Data Set (MDS) assessment of 08/22/3 documented the resident to have a Brief Interview for Mental Status (BIMS) of 15, indicating cognition was intact. Review of the care plans documented the resident had cellulitis of left foot and a 'skin tear' to the heel with adequate interventions in place to encourage resident to assist in positioning devices while in chair or bed, good nutrition and hydration, and that the resident is noncompliance with following up with the physician and nutrition / diet related to the wound. On 12/04/23 at 12:12 PM, an interview was conducted with Resident #33. He stated, 'they don't change my dressing on my foot and on my left heel every day.' Review of the Physicians orders for Resident #33 with a diagnoses of left foot Cellulitis and left heel open blister documented the following: On 11/07/23, the order for the left heel wound care documented Cleanse with wound cleaner / normal saline, pat dry, apply TAO (triple antibiotic ointment) to site followed with Xeroform, wrap with roll gauze daily. Protect peri (surrounding) wound with skin prep. Every day shift for wound care and every 8 hours as needed for loss of integrity. On 11/07/23, the order for the left heel wound care documented: Cleanse with wound cleaner / normal saline, pat dry, apply Medi honey for autolytic debridement followed by calcium alginate daily and PRN for wound care and/or loss of integrity. Protect peri wound with skin prep. Review of the TAR (Treatment Administration Record) for Resident #33 failed to show the wound on the heel and the wound of the left foot were changed daily as per the order. The record revealed the wound care was not completed on 11/13/23, 11/17/23, 11/19/23, 11/20/23, 11/27/23, 11/30/23, and 12/03/23. Antibiotics were ordered for left foot Cellulitis, as follows: On 10/25/23, Doxycycline100 mg by mouth every 8 hours for Cellulitis to be given for 10 days. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 11 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0684 On 11/06/23, the medication was continued for another 10 days. Level of Harm - Minimal harm or potential for actual harm On 11/20/23, Vancomycin 1250 mg every 12 hours to be given intravenously for every 12 hours. Residents Affected - Few On 11/29/23, Vancomycin was discontinued; and Daptomycin 500mg intravenously was ordered for 30 days for the left leg cellulitis/wound infection of the left foot. On 12/06/23 at approximately 10:12 AM, an interview was conducted with the Wound Care Nurse (WCN). She was asked who was responsible for the wound care and dressing change for Resident #33. She stated the nurses on the floor are supposed to be performing the wound care. She stated the resident is now assigned to her for his dressing changes. On 12/06/23 at approximately 10:22 AM, the wound care documentation was reviewed with the Director Of Nursing (DON) and the Regional Nurse who agreed there was missing documentation of wound care that was to be completed daily. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 12 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, interview, and policy review, it was determined, the facility staff failed to provide care and services to minimize complications for a resident with a gastronomy tube during medication administration. The failure affected 1 of 1 sampled resident (Resident #141). The findings included: Medication administration observation conducted on 12/05/23 starting at 10:22 AM revealed Staff A, a Registered Nurse, preparing medications for Resident #141. Staff A prepared two medications, Pepcid and Vimpat, crushed the medications separately and entered the room. The resident was sitting up in a chair and the tube feeding was off. Staff A then explained she needed to check for Gastronomy Tube (G Tube) placement and grabbed her stethoscope, listen to the resident's bowel sounds, then with her hands pressed down on the resident's abdomen. The staff then attached the syringe to the G Tube and poured thirty millimeters of tap water, then proceeded to administer the medications and flushed the G Tube with tap water to conclude the medication administration. Interview with Staff A conducted on 12/05/23 at approximately 10:40 AM, at the end of the observation, revealed her technique to check for G Tube placement is to listen to bowel sounds and in addition she pressed on the resident's abdomen and nothing came up. Staff A was asked if she aspirate the tube to check for residual and said she typically does not. Clinical record review conducted on 12/04/23 revealed Resident #141 was admitted to the facility on [DATE] with diagnoses including Traumatic Brain Injury, Malnutrition, Encephalopathy and Dysphagia. Review of the Minimum Data Set, admission assessment with reference date of 11/23/23 documented the resident has a feeding tube, and fifty one percent of calories are received from the tube feeding. Review of the Care Plan dated 11/21/23 documented the resident requires G-tube feeding related to subarachnoid hemorrhage, status post fall, traumatic brain injury, dysphagia and swallowing problem. The goal documented the resident will maintain adequate nutritional and hydration status through review date. The interventions include: Encourage and assist resident to keep the head of bed elevated. Follow physician orders regarding nutrition order and flushes. Check for tube placement and gastric contents/residual volume per facility protocol and record. Review of Physician's orders dated 11/21/23 documented, Enteral Tube: Verify Tube Placement before each use, if unable to verify placement notify the physician. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 13 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 Interview with the Nurse Consultant and the Director of Nursing (DON) on 12/06/23 at 10:52 AM revealed the facility does not have a policy delineating how to check tube placement and stated most likely checking placement is no longer required. The surveyor requested policy delineating the process for checking G Tube placement, as there is a physician order to check tube placement before each use and there is a policy requiring the G Tube placement be verified prior to medication administration. Residents Affected - Few On 12/06/23 at approximately 12:40 PM the DON provided another policy, stating this is the new policy delineating how the staff is to check for G Tube placement. Policy titled Administering Medications through an Enteral Tube, revised 05/2023 documents the following: Standard The purpose of this procedure is to provide guidelines for the safe administration of medications through an enteral tube. Preparation 1. Verify that there is a physician's medication order for this procedure. 2. Review the resident's care plan to assess any special needs of the resident. 3. Assemble the equipment and supplies as needed . 6. Verify placement of feeding tube. a. If you suspect improper tube positioning, do not administer feeding or medication. Notify the Charge Nurse or Physician. b. Placement can be verified by radiological diagnostic study or PH strips and by verifying gastric contents are present. Based on the observation, physician's orders and policies and procedures, Staff A failed to check G Tube placement prior to administering medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 14 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, record review and interview, the facility failed to ensure licensed nurses were able to demonstrate competency related to the acquisition and provision of medication administration. The failure affected 1 of 6 sampled residents (Resident #27). The findings included: Facility policy titled Medication Shortages/Unavailable Medications, not dated documents the following: When medications are not received or are unavailable for the customers, the licensed nurse will urgently initiate action in cooperation with the attending physician and the pharmacy provider. PROCEDURE If a medication shortage is noted at the time of medication administration (Med-pass), the licensed nurse or certified medication assistant must immediately initiate action to obtain the medication and not wait until the med pass is completed. B. If a medication shortage is noted during normal pharmacy hours: 1. A licensed nurse notifies the pharmacy and speaks to a registered pharmacist to determine the status of the order. Facility link may also be utilized to order or reorder medications and/or determine the status of a new or re-ordered medication. If not ordered, place the order or re-order to be sent with the next scheduled delivery. 2. If the next available delivery results in a delay or missed dose in the customer's medication schedule, take the medication from the emergency stock supply to administer the dose. If ordered medication is not available in the emergency stock, notify the pharmacist that an emergency delivery is required. 3. If medication from emergency stock is utilized -ensure that the pharmacy received the faxed information (i.e. customer name, drug, dose) for replacement and appropriate billing. c. If a medication shortage is noted after normal pharmacy hours: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 15 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0726 1. Level of Harm - Minimal harm or potential for actual harm A licensed nurse obtains the ordered medication from the emergency stock supply. 2. Residents Affected - Few If the ordered medication is unavailable in the emergency stock supply, a licensed nurse calls the pharmacy emergency answering service and request to speak with the registered pharmacist on call to determine the plan of action which may include: a. Emergency/Stat delivery. D. If an b. emergency Use of emergency delivery is not (back-up) feasible, pharmacy. a licensed nurse contacts the attending physician to obtain orders or directions which may include: 1. Holding the dose/doses. 2. Use of an alternative medication available from the emergency stock supply. 3. Change in order (time of administration or medication). E. If the medication is unavailable and cannot be supplied from the manufacturer, a registered pharmacist informs the licensed nurse and attending physician of the expected date of availability and/or a therapeutically equivalent alternative medication. 1. Obtain alternate physician orders, as necessary. Orders may include: a. Holding the dose/doses until the medication is available. b. Use of an alternative medication. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 16 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0726 2. Level of Harm - Minimal harm or potential for actual harm If unable to obtain a response from the attending physician in a timely manner, notify nursing supervisor and contact the Medical Director for orders/direction Residents Affected - Few a. Explain the circumstances of the drug product shortage to obtain an appropriate order. F. When a missed dose is unavoidable: 1. Document missed dose on the Medication Administration Record (MAR) or Treatment Administration Record (TAR): a. Initial and circle to indicate any missed dose. Document explanation for missed dose according to physicians order: e.g. hold dose on back of MAR/TAR and indicate See nurses notes for explanation 2. Document explanation of missed dose in the Nurses Notes: a. Describe circumstances of medication shortage. b. Notification of pharmacy and response. c. Action(s) taken. Clinical record review conducted on 12/04/23 revealed Resident #27 was admitted to the facility on [DATE] with diagnoses of Leukemia, Chronic Kidney Disease, Orthostatic Hypotension and Heart Failure. Review of Physician's orders dated 11/16/23 documented Sodium Bicarbonate tablet 325 milligrams, give one tablet by mouth two times a day for Metabolic Acidosis related to Chronic Kidney Disease. Review of Medication Administration Records (MAR) dated 11/2023 and 12/2023 indicates Resident #27 did not receive the prescribed Sodium Bicarbonate, due to not being available on the following dates. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 17 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The MAR documented on 11/19/23 (morning and evening doses), 11/22/23 (morning and evening doses), 11/24/23 (evening dose), 11/29/23 (morning and evening dose), 11/30/23 (evening dose), and 12/04/23 (morning and evening dose), the medication was not available. Interview with the Director of Nursing (DON) on 12/07/23 at 11:40 AM confirmed Resident #27 has missed multiple doses of the prescribed Sodium Bicarbonate, the central supply staff went to Walgreens looking for it last week, and was not aware the medication was not available in November. The DON explained the medication is a stock item and the nurses advise the central supply staff when to reorder. In addition, if not available, the nurses can contact the pharmacy to send a replacement. The DON reviewed the clinical record and confirmed there is no documentation that the prescriber was notified of the medication unavailability, or other efforts to obtain or substitute the medication. The investigation determined the facility's licensed staff failed to follow physician's orders for Resident #27 and failed to administer medications as ordered. In addition, the facility licensed staff failed to follow pharmacy policies and procedures related to acquiring and administering medications. The licensed staff failed to ensure Resident #27 received medications as ordered, failed to document reasons why medications were not obtained from the pharmacy or stock supply, failed to document communication with the physician and failed to document actions taken to obtain or substitute the prescribed drugs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 18 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy review and interview, the facility staff failed to ensure antibiotic prescribing criteria includes clinical signs and symptoms, laboratory reports and appropriate monitoring to protect residents from harm caused by unnecessary antibiotic use, and to combat antibiotic resistance. The failure affected 1 of 6 sampled residents (Resident #27). Residents Affected - Few The findings included: Clinical record review revealed Resident #27 was admitted to the facility on [DATE] with diagnoses including Leukemia and Malnutrition. Review of the Minimum Data Set, admission assessment with reference date of 11/18/23 documented the resident was assessed as moderately impaired for skills of daily decision making; exhibited no behaviors, has an urinary catheter and is receiving oxygen therapy. Review of the Care Plan dated 11/17/23, titled revealed, The resident has a risk for injury/infection related to the presence of supra pubic catheter secondary to a diagnosis of neurogenic bladder, obstructive uropathy and prostate cancer. The interventions included to monitor for signs of bacteriuria: pain, burning, blood-tinged urine, cloudiness, no output, deepening of urine color, increased pulse, increased temperature, urinary frequency, foul smelling urine, fever, chills, altered mental status, change in behavior, change in eating patterns. The staff is to report abnormalities to nurse/physician as needed. Review of the Physician's Orders revealed an entry dated 11/29/23 for urine culture and to start Cipro 500 mg twice day for seven days, antibiotic therapy to treat Urinary Tract Infection. Review of the progress notes failed to document signs and symptoms of a urinary tract infection. laboratory results dated [DATE] documents negative urine culture, no growth in 24 hours. Interview with the Director of Nursing conducted on 12/06/23 at 12:35 PM confirmed Resident #27's laboratory results are negative for a urinary tract infection and there is no documentation of change in condition, signs and symptoms of an urinary tract infection. Interview with the Nurse Practitioner (APRN) who ordered the antibiotic therapy and the Director of Nursing conducted on 12/06/23 at 12:40 PM revealed the APRN prescribed the antibiotic therapy because the resident was exhibiting behaviors, removing his clothing. The ARNP stated that she will discontinue the antibiotic. Facility policy titled Antibiotic Stewardship, revised 02/2023, documents as follows: Antibiotic will be prescribed and administered to residents under the guidance of the facility's Antibiotic Stewardship Program. If an antibiotic is indicated, prescribers will provide complete antibiotic orders including the following elements, drug name, dose, frequency, duration, route and indication for use. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 19 of 20 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 106148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Jupiter Rehabilitation Center (the) 674 Pioneer Road Jupiter, FL 33458 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 0881 When a nurse calls a physician/prescriber to communicate a suspected infection, he or she will have the following information available: Level of Harm - Minimal harm or potential for actual harm a. Residents Affected - Few Signs and symptoms b. When symptoms were first observed c. Resident hydration status d. Current medication list e. Allergy information f. Infection type g. Any orders for warfarin and last INR h. Last creatinine clearance or serum creatinine if available i. Time of last antibiotic dose if applicable. When a culture and sensitivity is ordered lab results and the current clinical situation will be communicated to the prescriber as soon as available to determine if antibiotic therapy should be started, continued, modified or discontinued. The review determined Resident #27 was prescribed antibiotic therapy based on a behavior, removing his clothing. The nursing staff failed to document the resident change in condition and failed to promptly notify the prescriber of the negative laboratory test results dated 11/30/23. Resident #27 received six days of antibiotic therapy with no indication for use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106148 If continuation sheet Page 20 of 20