Inspection·September 6, 2023

K 000 INITIAL COMMENTS K 000 An unannounced Fire & Life Safety relicensure survey was conducted on 09/06/23 at Nursing Center at La Posada, a nursing home in Palm Beach Gardens, Florida in accordance with National Fire Protection Association (NFPA) 1 and 101 (2018 Edition) and applicable requirements of Florida State Fire Marshal's Rules and Regulations, Florida Administrative Code (F.A.C.) 69A-3, F.A.C. 69A-53, F.A.C. 59A-4, and Florida Statutes (F.S.) 400 Part II, and F.S. 633.0215, adopting National Fire Protection Association (NFPA) 1 and 101 (2018 Edition) known as the Florida Fire Prevention Code and all NFPA referenced standards and requirements adopted per NFPA 101, Chapter 2. The following is description of the deficiencies, found at the time of the visit.

K 353 NFPA 101 Sprinkler System - Maintenance and SS=D Testing K 353 10/6/23 Sprinkler System - Maintenance and Testing Automatic sprinkler and standpipe systems are inspected, tested, and maintained in accordance with NFPA 25, Standard for the Inspection, Testing, and Maintaining of Water-based Fire Protection Systems. Records of system design, maintenance, inspection and testing are maintained in a secure location and readily available. a) Date sprinkler system last checked b) Who provided system test c) Water system supply source Provide in REMARKS information on coverage for any non-required or partial automatic sprinkler 35961005 09/06/2023 NURSING CENTER AT LA POSADA, THE 3600 MASTERPIECE WAY PALM BEACH GARDENS, FL 33410

K 353 Continued From page 1 system. 9.7.5, 9.7.7, 9.7.8, and NFPA 25 This Statute or Rule is not met as evidenced by: Based on record review and staff interviews, the facility failed to maintain their backflow device in accordance with NFPA 101. The findings included: On 09/06/23 between the hours of 9:45 AM through 11:00 AM while conducting record review with the Maintenance Director, the facility could not provide any documentation as to when the last 5-year internal of the backflow was completed. No previous report was provided. An interview was conducted with the Maintenance Director concurrent with the record review and confirmed the findings. Class III NFPA 101 (2018 edition) 19.7.6, 4.6.12 NFPA 25 (2017 edition) 13.7.1.3

K 353 The statements made on this Plan of Correction are not and do not constitute an agreement with the alleged deficiencies herein. To remain in compliance with all Federal & State regulations, the center has taken or will take the actions set forth in the following plan of correction. No residents were affected by the lack of a 5 year backflow test. Seacoast Utility completed the maintenance and testing of the back flow (5 year test) on 9/25/2023. The facility maintenance director has been re educated on the importance of completing required inspections. The facility maintenance program has been updated to reflect when the next 5 year internal inspection needs to be scheduled. The Maintenance Director/designee will ensure the inspection requirements are performed to meet the standard requirements as identified in our preventative maintenance program and will report those findings in the monthly QAPI. STATE FORM 05BM21 106067 09/06/2023 NURSING CENTER AT LA POSADA, THE 3600 MASTERPIECE WAY PALM BEACH GARDENS, FL 33410 PREFIX TAG ID PREFIX TAG PROVIDER'S PLAN OF ACTION CORRECTION DEFICIENCY) COMPLETION DATE

K 000 INITIAL COMMENTS

K 000 An unannounced Fire & Life Safety recertification survey was conducted 09/06/23 at Nursing Center at La Posada, a nursing home in Palm Beach Gardens, Florida. The facility is in compliance with 42 CFR 483.90 (a), and National Fire Protection Association (NFPA) 101 (2012 Edition), NFPA 99 (2012 Edition) requirements for nursing homes. Initial Plan Review: 2001 Existing NFPA 220 Construction Type: II (111) Number of beds: 40 Census: 37 The facility was found in compliance at the time of this survey. 09/25/2023 106067 09/06/2023 NURSING CENTER AT LA POSADA, THE 3600 MASTERPIECE WAY PALM BEACH GARDENS, FL 33410 PREFIX TAG

E 000 Initial Comments During the Fire & Life Safety recertification survey conducted on 09/06/23 at Nursing Center at La Posada, a nursing home, the Emergency Preparedness Program (EPP) was reviewed. Nursing Center at La Posada, is in compliance with Emergency Preparedness rule per CFR (Code of Federal Regulations) 42, Part 483.73, Requirement for Long Term Care Facilities. The facility was found in compliance at the time of the survey. ID PREFIX TAG

E 000 DEFICIENCY) COMPLETION DATE 09/25/2023