Inspection·May 31, 2024

K 000 INITIAL COMMENTS

K 000 A re-licensure survey was conducted on 05/30/2024-05/31/2024 at Riviera Health Resort, a nursing home in Coral Gables, Florida in accordance with National Fire Protection Association (NFPA) 1 and 101 (2021 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 (2021 edition) known as the Florida Fire Prevention Code and all NFPA referenced standards and requirements adopted per NFPA 101, Chapter 2. The following is a description of the deficiencies found at the time of the visit.

K 353 NFPA 101 Sprinkler System - Maintenance and SS=D Testing

K 353 7/1/24 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 06/14/24 STATE FORM 6809 RKKY21 35961025 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

K 353 Continued From page 1 system. 9.7.5, 9.7.7, 9.7.8, and NFPA 25

K 353 This Statute or Rule is not met as evidenced by: Based on observation and staff interview, the facility failed to maintain the automatic sprinkler system in accordance with NFPA 101. Tag 0353- NFPA 101 Sprinkler System- Maintenance and Testing (LSC 2021 Health Existing) Findings included: What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice? During the Life Safety Survey tour of the facility at 3:20 pm on 05/31/2024 with the Maintenance Director, it was observed that: (1) there was no spare sprinkler list posted on sprinkler cabinet in the Pump Room; and (2) there was no dry spare sprinkler for freezer nor means of returning the system to service. There were no residents identified nor affected by this alleged deficient practice. During the staff interview at 3:20 pm on 05/31/2024, the Maintenance Director acknowledged these findings. These findings were also discussed and acknowledged by the Administrator during the exit conference. How will you identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken? NFPA 101 (2021 Edition) 19.1.1.3, 4.6.12, 4.6.12.1, 9.11 through 9.11.3.2 NFPA 25 (2020 Edition) 5.4.1.5.6, 5.4.1.5.6.1 (1-4), and 5.4.1.5.3 Class III Residents are not found to be affected by this alleged deficient practice. What measures will be put in place or what systemic changes you will make to ensure that the deficient practice does not recur? The contracted sprinkler vendor provided the spare sprinkler list and is posted on the sprinkler cabinet located in the Pump room. The dry spare sprinkler for freezer is on the sprinkler cabinet in the Pump room. The Maintenance Director or designee will monitor the Pump room, monthly, for three consecutive months, to ensure the spare sprinkler list is posted on STATE FORM notes RKKY21 35961025 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

K 353 Continued From page 2

K 353 the sprinkler cabinet and the dry spare sprinkler for freezer is present. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e. what quality assurance program will be put in place? The Maintenance Director or designee will monitor the Pump room, monthly, for three consecutive months, to ensure the spare sprinkler list is posted on the sprinkler cabinet and the dry spare sprinkler for freezer is present on the sprinkler cabinet. The Maintenance Director or designee will report the findings to the Quality Assurance and Performance Improvement committee, monthly, and will determine if any additional actions are needed.If any deficient practice is noted, then the committee will make recommendations to achieve compliance. This Plan of Correction does not constitute an admission that the deficiencies alleged did in fact exist. The Plan of Correction is filed as evidence of the facility: s desire to comply with the requirements and to continue to provide high quality resident care.

K 918 NFPA 99 Electrical Systems - Essential Electric SS=D Syste

K 918 7/1/24 STATE FORM notes RKKY21 35961025 05/31/2024 6901 YUMURI STREET CORAL GABLES, FL 33156

K 918 Continued From page 3 K 918 The generator or other alternate power source and associated equipment is capable of supplying service within 10 seconds. If the 10-second criterion is not met during the monthly test, a process shall be provided to annually confirm this capability for the life safety and critical branches. Maintenance and testing of the generator and transfer switches are performed in accordance with NFPA 110. Generator sets are inspected weekly, exercised under load 30 minutes 12 times a year in 20-40 day intervals, and exercised once every 36 months for 4 continuous hours. Scheduled test under load conditions include a complete simulated cold start and automatic or manual transfer of all EES loads, and are conducted by competent personnel. Maintenance and testing of stored energy power sources (Type 3 EES) are in accordance with NFPA 111. Main and feeder circuit breakers are inspected annually, and a program for periodically exercising the components is established according to manufacturer requirements. Written records of maintenance and testing are maintained and readily available. EES electrical panels and circuits are marked and readily identifiable. Minimizing the possibility of damage of the emergency power source is a design consideration for new installations. 6.4.4, 6.5.4, 6.6.4 (NFPA 99), NFPA 110, NFPA 111, 700.10 (NFPA 70) This Statute or Rule is not met as evidenced by: Based on observations and staff interview, the facility failed to maintain the Emergency Power Supply System (EPSS) generator in accordance with NFPA 101. Findings included: Tag 0918- NFPA 101 Electrical Systems-Essential Electric System(LSC 2021 Health Existing) What corrective action(s) will be accomplished for those residents found to 35961025 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

K 918 Continued From page 4 During the Life Safety Survey tour of the facility at 3:15 pm on 05/31/2024 with the Maintenance Director, it was observed that there were no generator high mortality spare parts in Generator Room. During the Staff Interview at 3:15 pm on 05/31/2024, the Maintenance Director acknowledged this finding. This finding was also discussed and acknowledged by the Administrator during the exit conference. NFPA 101 (2021 Edition) 19.7.6, 4.6.12, 4.6.12.1 NFPA 110 (2019 Edition) 8.2 through 8.2.4.1 Class III

K 918 have been affected by the deficient practice? There were no residents identified nor affected by this alleged deficient practice. How will you identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken? Residents are not found to be affected by this alleged deficient practice. What measures will be put in place or what systemic changes you will make to ensure that the deficient practice does not recur? The generators’ high mortality spare parts were obtained from the contracted generator vendor and were stored in the generator room. The generator high mortality parts will be rotated yearly. A generator monthly log was created to include the par levels to the high mortality spare parts. The Maintenance Director or designee will monitor the generator room, monthly, for three consecutive months, to ensure par levels to the high mortality spare parts are maintained. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e. what quality assurance program will be put in place? The Maintenance Director or designee will STATE FORM notes RKKY21 35961025 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

K 918 Continued From page 5

K 918 monitor the generator room, monthly, for three consecutive months, to ensure par levels to the high mortality spare parts are maintained. The Maintenance Director or designee will report the findings to the Quality Assurance and Performance Improvement committee, monthly, and will determine if any additional actions are needed.If any deficient practice is noted, then the committee will make recommendations to achieve compliance. This Plan of Correction does not constitute an admission that the deficiencies alleged did in fact exist. The Plan of Correction is filed as evidence of the facility.'s desire to comply with the requirements and to continue to provide high quality resident care. STATE FORM ndas RKKY21 05/31/2024 6901 YUMURI STREET CORAL GABLES, FL 33156 DEFICIENCY) (X8) COMPLETION DATE

K 000 INITIAL COMMENTS K 000 An unannounced Fire & Life Safety recertification survey was conducted 05/30/2024-05/31/2024 at Riviera Health Resort, a nursing home in Coral Gables, Florida. The facility is not in compliance with 42 CFR 483.90 (a), and National Fire Protection Association (NFPA) 101 (2012 edition), NFPA 99 (2012) requirements for nursing homes. Initial Plan Review: 2011 Existing NFPA 220 Construction Type: I (332) Number of beds: 223 Census: 199

K 353 Sprinkler System - Maintenance and Testing K 353 7/1/24 SS=D CFR(s): NFPA 101 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 Maintenance 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 system. 9.7.5, 9.7.7, 9.7.8, and NFPA 25 106094 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX COMPLETION DATE

K 353 K 353 Continued From page 1 Tag 0353- NFPA 101 Sprinkler System- This REQUIREMENT is not met as evidenced Maintenance and Testing (LSC 2012 Health by: Existing) Based on observation and staff interview, the facility failed to maintain the automatic sprinkler system in accordance with NFPA 101. Findings included: During the Life Safety Survey tour of the facility at 3:20 pm on 05/31/2024 with the Maintenance Director, it was observed that: (1) there was no spare sprinkler list posted in sprinkler cabinet in the Pump Room; and (2) there was no dry spare sprinkler for freezer nor means of returning the system to service. During the staff interview at 3:20 pm on 05/31/2024, the Maintenance Director acknowledged these findings. These findings were also discussed and acknowledged by the Administrator during the exit conference. NFPA 101 (2012 Edition) 19.3.5, 19.3.5.1, 9.7, 9.7.1.1, 9.7.5 NFPA 25 (2011 Edition) 5.4.1.4.2.1 NFPA 13 (2010 Edition) 6.2.9.7, 6.2.9.7.1(1-4) What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice? There were no residents identified nor affected by this alleged deficient practice. How will you identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken? Residents are not found to be affected by this alleged deficient practice. What measures will be put in place or what systemic changes you will make to ensure that the deficient practice does not recur? The contracted sprinkler vendor provided the spare sprinkler list and is posted on the sprinkler cabinet located in the Pump room. The dry spare sprinkler for freezer is on the sprinkler cabinet in the Pump room. The Maintenance Director or designee will monitor the Pump room, monthly, for three consecutive months, to ensure the spare sprinkler list is posted on the sprinkler cabinet and the dry spare RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

K 353 Continued From page 2

K 353 sprinkler for freezer is present. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e. what quality assurance program will be put in place? The Maintenance Director or designee will monitor the Pump room, monthly, for three consecutive months, to ensure the spare sprinkler list is posted on the sprinkler cabinet and the dry spare sprinkler for freezer is present on the sprinkler cabinet. The Maintenance Director or designee will report the findings to the Quality Assurance and Performance Improvement committee, monthly, and will determine if any additional actions are needed.If any deficient practice is noted, then the committee will make recommendations to achieve compliance. This Plan of Correction does not constitute an admission that the deficiencies alleged did in fact exist. The Plan of Correction is filed as evidence of the facility 's desire to comply with the requirements and to continue to provide high quality resident care.

K 918 Electrical Systems - Essential Electric Syste SS=D CFR(s): NFPA 101

K 918 7/1/24 Electrical Systems - Essential Electric System Maintenance and Testing 05/31/2024 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX PREFIX COMPLETION DATE

K 918 Continued From page 3 K 918 The generator or other alternate power source and associated equipment is capable of supplying service within 10 seconds. If the 10-second criterion is not met during the monthly test, a process shall be provided to annually confirm this capability for the life safety and critical branches. Maintenance and testing of the generator and transfer switches are performed in accordance with NFPA 110. Generator sets are inspected weekly, exercised under load 30 minutes 12 times a year in 20-40 day intervals, and exercised once every 36 months for 4 continuous hours. Scheduled test under load conditions include a complete simulated cold start and automatic or manual transfer of all EES loads, and are conducted by competent personnel. Maintenance and testing of stored energy power sources (Type 3 EES) are in accordance with NFPA 111. Main and feeder circuit breakers are inspected annually, and a program for periodically exercising the components is established according to manufacturer requirements. Written records of maintenance and testing are maintained and readily available. EES electrical panels and circuits are marked, readily identifiable, and separate from normal power circuits. Minimizing the possibility of damage of the emergency power source is a design consideration for new installations. 6.4.4, 6.5.4, 6.6.4 (NFPA 99), NFPA 110, NFPA 111, 700.10 (NFPA 70) This REQUIREMENT is not met as evidenced by: Based on observations and staff interview, the facility failed to maintain the Emergency Power Supply System (EPSS) generator in accordance with NFPA 101. Tag 0918- NFPA 101 Electrical Systems- Essential Electric System(LSC 2012 Health Existing) PROVIDERS OF DEFICIENCIES 106094 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

K 918 Continued From page 4 Findings included:

K 918 During the Life Safety Survey tour of the facility at 3:15 pm on 05/31/2024 with the Maintenance Director, it was observed that there were no generator high mortality spare parts in Generator Room. What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice? There were no residents identified nor affected by this alleged deficient practice. During the Staff Interview at 3:15 pm on 05/31/2024, the Maintenance Director acknowledged this finding. This finding was also discussed and acknowledged by the Administrator during the exit conference. How will you identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken? Residents are not found to be affected by this alleged deficient practice. NFPA 99 (2012 Edition) 6.4.4.1.1.1, 6.4.4.1.1.3 NFPA 110 (2010 Edition) 8.2 through 8.2.4.1 What measures will be put in place or what systemic changes you will make to ensure that the deficient practice does not recur? The generators : high mortality spare parts were obtained from the contracted generator vendor and were stored in the generator room. The generator high mortality parts will be rotated yearly. A generator monthly log was created to include the par levels to the high mortality spare parts. The Maintenance Director or designee will monitor the generator room, to monthly, for three consecutive months, to ensure par levels to the high mortality spare parts are maintained. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e. what quality assurance 106094 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

K 918 Continued From page 5

K 918 program will be put in place? The Maintenance Director or designee will monitor the generator room, monthly, for three consecutive months, to ensure par levels to the high mortality spare parts are maintained. The Maintenance Director or designee will report the findings to the Quality Assurance and Performance Improvement committee, monthly, and will determine if any additional actions are needed.If any deficient practice is noted, then the committee will make recommendations to achieve compliance. This Plan of Correction does not constitute an admission that the deficiencies alleged did in fact exist. The Plan of Correction is filed as evidence of the facility's desire to comply with the requirements and to continue to provide high quality resident care. 106094 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX PREFIX DEFICIENCY) (X8) COMPLETION DATE

E 000 Initial Comments E 000 During an unannounced Fire & Life Safety recertification survey conducted on 05/30/2024-05/31/2024 at Riviera Health Resort, a nursing home in Coral Gables, Florida, Emergency Preparedness was reviewed. Riviera Health Resort is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 483.73, Requirement for Long-Term Care Facilities. 35961025 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

K 000 INITIAL COMMENTS

K 000 A re-licensure survey was conducted on 05/30/2024-05/31/2024 at Riviera Health Resort, a nursing home in Coral Gables, Florida in accordance with National Fire Protection Association (NFPA) 1 and 101 (2021 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 (2021 edition) known as the Florida Fire Prevention Code and all NFPA referenced standards and requirements adopted per NFPA 101, Chapter 2. The following is a description of the deficiencies found at the time of the visit.

K 353 NFPA 101 Sprinkler System - Maintenance and SS=D Testing

K 353 7/1/24 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 (X8) DATE 06/14/24 STATE FORM 6809 RKKY21 35961025 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

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 observation and staff interview, the facility failed to maintain the automatic sprinkler system in accordance with NFPA 101. Findings included: During the Life Safety Survey tour of the facility at 3:20 pm on 05/31/2024 with the Maintenance Director, it was observed that: (1) there was no spare sprinkler list posted in sprinkler cabinet in the Pump Room; and (2) there was no dry spare sprinkler for freezer nor means of returning the system to service. During the staff interview at 3:20 pm on 05/31/2024, the Maintenance Director acknowledged these findings. These findings were also discussed and acknowledged by the Administrator during the exit conference. NFPA 101 (2021 Edition) 19.1.1.3, 4.6.12, 4.6.12.1, 9.11 through 9.11.3.2 NFPA 25 (2020 Edition) 5.4.1.5.6, 5.4.1.5.6.1 (1-4), and 5.4.1.5.3 Class III

K 353

K 918 NFPA 99 Electrical Systems - Essential Electric SS=D Syste Electrical Systems - Essential Electric System Maintenance and Testing The generator or other alternate power source and associated equipment is capable of supplying service within 10 seconds. If the 10-second

K 918 7/1/24 STATE FORM notes RKKY21 35961025 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

K 918 Continued From page 2 criterion is not met during the monthly test, a process shall be provided to annually confirm this capability for the life safety and critical branches. Maintenance and testing of the generator and transfer switches are performed in accordance with NFPA 110. Generator sets are inspected weekly, exercised under load 30 minutes 12 times a year in 20-40 day intervals, and exercised once every 36 months for 4 continuous hours. Scheduled test under load conditions include a complete simulated cold start and automatic or manual transfer of all EES loads, and are conducted by competent personnel. Maintenance and testing of stored energy power sources (Type 3 EES) are in accordance with NFPA 111. Main and feeder circuit breakers are inspected annually, and a program for periodically exercising the components is established according to manufacturer requirements. Written records of maintenance and testing are maintained and readily available. EES electrical panels and circuits are marked and readily identifiable. Minimizing the possibility of damage of the emergency power source is a design consideration for new installations. 6.4.4, 6.5.4, 6.6.4 (NFPA 99), NFPA 110, NFPA 111, 700.10 (NFPA 70) This Statute or Rule is not met as evidenced by: Based on observations and staff interview, the facility failed to maintain the Emergency Power Supply System (EPSS) generator in accordance with NFPA 101. Findings included: During the Life Safety Survey tour of the facility at 3:15 pm on 05/31/2024 with the Maintenance Director, it was observed that there were no

K 918 STATE FORM notes RKKY21 35961025 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

K 918 Continued From page 3 generator high mortality spare parts in Generator Room. During the Staff Interview at 3:15 pm on 05/31/2024, the Maintenance Director acknowledged this finding. This finding was also discussed and acknowledged by the Administrator during the exit conference. NFPA 101 (2021 Edition) 19.7.6, 4.6.12, 4.6.12.1 NFPA 110 (2019 Edition) 8.2 through 8.2.4.1 Class III

K 918 STATE FORM notes RKKY21 106094 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 ID PROVIDER'S PLAN OF ACTION PREFIX TAG DEFICIENCY) COMPLETION DATE

K 000 INITIAL COMMENTS K 000 An unannounced Fire & Life Safety recertification survey was conducted 05/30/2024-05/31/2024 at Riviera Health Resort, a nursing home in Coral Gables, Florida. The facility is not in compliance with 42 CFR 483.90 (a), and National Fire Protection Association (NFPA) 101 (2012 edition), NFPA 99 (2012) requirements for nursing homes. Initial Plan Review: 2011 Existing NFPA 220 Construction Type: I (332) Number of beds: 223 Census: 199

K 353 Sprinkler System - Maintenance and Testing SS=D CFR(s): NFPA 101

K 353 7/1/24 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 Maintenance 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 system. 9.7.5, 9.7.7, 9.7.8, and NFPA 25 06/14/2024 106094 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX PREFIX COMPLETION DATE

K 353 Continued From page 1 K 353 This REQUIREMENT is not met as evidenced by: Based on observation and staff interview, the facility failed to maintain the automatic sprinkler system in accordance with NFPA 101. Findings included: During the Life Safety Survey tour of the facility at 3:20 pm on 05/31/2024 with the Maintenance Director, it was observed that: (1) there was no spare sprinkler list posted in sprinkler cabinet in the Pump Room; and (2) there was no dry spare sprinkler for freezer nor means of returning the system to service. During the staff interview at 3:20 pm on 05/31/2024, the Maintenance Director acknowledged these findings. These findings were also discussed and acknowledged by the Administrator during the exit conference. NFPA 101 (2012 Edition) 19.3.5, 19.3.5.1, 9.7, 9.7.1.1, 9.7.5 NFPA 25 (2011 Edition) 5.4.1.4.2.1 NFPA 13 (2010 Edition) 6.2.9.7, 6.2.9.7.1(1-4) CFR(s): NFPA 101

K 918 Electrical Systems - Essential Electric Syste SS=D Electrical Systems - Essential Electric System Maintenance and Testing The generator or other alternate power source and associated equipment is capable of supplying service within 10 seconds. If the 10-second criterion is not met the monthly test, a process shall be provided to annually confirm this capability for the life safety and critical branches. Maintenance and testing of the generator and K 918 7/1/24 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX PREFIX COMPLETION DATE

K 918 Continued From page 2 K 918 transfer switches are performed in accordance with NFPA 110. Generator sets are inspected weekly, exercised under load 30 minutes 12 times a year in 20-40 day intervals, and exercised once every 36 months for 4 continuous hours. Scheduled test under load conditions include a complete simulated cold start and automatic or manual transfer of all EES loads, and are conducted by competent personnel. Maintenance and testing of stored energy power sources (Type 3 EES) are in accordance with NFPA 111. Main and feeder circuit breakers are inspected annually, and a program for periodically exercising the components is established according to manufacturer requirements. Written records of maintenance and testing are maintained and readily available. EES electrical panels and circuits are marked, readily identifiable, and separate from normal power circuits. Minimizing the possibility of damage of the emergency power source is a design consideration for new installations. 6.4.4, 6.5.4, 6.6.4 (NFPA 99), NFPA 110, NFPA 111, 700.10 (NFPA 70) This REQUIREMENT is not met as evidenced by: Based on observations and staff interview, the facility failed to maintain the Emergency Power Supply System (EPSS) generator in accordance with NFPA 101. Findings included: During the Life Safety Survey tour of the facility at 3:15 pm on 05/31/2024 with the Maintenance Director, it was observed that there were no generator high mortality spare parts in Generator Room. 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

K 918 Continued From page 3

K 918 During the Staff Interview at 3:15 pm on 05/31/2024, the Maintenance Director acknowledged this finding. This finding was also discussed and acknowledged by the Administrator during the exit conference. NFPA 99 (2012 Edition) 6.4.4.1.1, 6.4.4.1.1.3 NFPA 110 (2010 Edition) 8.2 through 8.2.4.1 05/31/2024 RIVIERA HEALTH RESORT 6901 YUMURI STREET CORAL GABLES, FL 33156 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

E 000 Initial Comments

E 000 During an unannounced Fire & Life Safety recertification survey conducted on 05/30/2024-05/31/2024 at Riviera Health Resort, a nursing home in Coral Gables, Florida, Emergency Preparedness was reviewed. Riviera Health Resort is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 483.73, Requirement for Long-Term Care Facilities. 06/14/2024