Inspection·March 11, 2026

K0000 INITIAL COMMENTS

K0000 /2026 An unannounced Fire & Life Safety Recertification survey was conducted on Wellington Rehabilitation Center (The), a Luxe at nursing home in Wellington, Florida. Luxe at Wellington Rehabilitation Center, The is not in compliance with 42 CFR 483 Subpart B, 42 CFR 488.307, and National Fire Protection Association (NFPA) 101 (2012 Edition), NFPA 99 (2012 Edition) requirements for nursing homes. Initial Plan Review: 2011 Existing NFPA 220 Construction Type: I (332) Number of beds: 120 Census: 88 The following is a description of the noncompliance.

K0324 SS = F Cooking Facilities CFR(s): NFPA 101 Cooking Facilities

K0324

K0324 – Cooking Facilities /2026 Cooking equipment is protected in accordance with NFPA 96, Standard for Control and Fire Protection of Commercial Cooking Operations, unless: * residential cooking equipment (i.e., small appliances such as microwaves, hot plates, toasters) are used for food warming or limited cooking in accordance with 18.3.2.5.2, 19.3.2.5.2 * cooking facilities open to the corridor in smoke compartments with 30 or fewer patients comply with the conditions under 18.3.2.5.3, 19.3.2.5.3, or * cooking facilities in smoke compartments with 30 or fewer patients comply with conditions under 18.3.2.5.4, 19.3.2.5.4. Immediate Corrective Action: On high temperature sealant was purchased. On 1 all seams of the commercial kitchen hood suppression system were sealed using the approved food grade to ensure grease tight integrity. Identification of Other Residents Potentially Affected: All residents had the potential to be affected; however, based on observation, no residents were Measures to Prevent Recurrence: On , re education was provided to the Director of Maintenance and maintenance staff regarding maintenance of commercial cooking operations in accordance with NFPA 101. Education focused on ensuring 106091 LUXE AT WELLINGTON REHABILITATION CENTER THE 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0324 SS = F Continued from page 1

K0324 Continued from page 1 /2026 Cooking facilities protected according to NFPA 96 per 9.2.3 are not required to be enclosed as hazardous areas, but shall not be open to the corridor. 18.3.2.5.1 through 18.3.2.5.4, 19.3.2.5.1 through 19.3.2.5.5, 9.2.3, This STANDARD is NOT MET as evidenced by: Based on observation and staff interview, the facility failed to maintain their commercial cooking facility in accordance with NFPA 101. For 1 of 1 commercial cooking hood suppression system. This deficiency affects all residents and staff in the facility. The findings included: On , at 3:30 PM, during the fire safety tour of the facility with the Maintenance Director, observations revealed the commercial cooking hood suppression system seams were not sealed or otherwise made grease tight. An interview was conducted with the Regional Maintenance Director concurrently with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on at 5:15 PM. NFPA 96 (2011 Edition) 5.1.4 NFPA 101 (2012 Edition) 2.1, 4.5.8, 4.6.12.1, 9.2.3, 19.3.2.5.1 Photographic evidence obtained.

K0345 SS = F Fire Alarm System - Testing and Maintenance

K0345 The statements made on this Plan of Correction do not constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility's compliance with applicable federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated. /2026 Fire Alarm System - Testing and Maintenance Immediate Corrective Action: hood suppression system seals remain grease tight and that any deficiencies are reported and corrected immediately. Monitoring: The Director of Maintenance or designee will conduct weekly audits for four (4) weeks, followed by monthly audits for two (2) months, to verify continued compliance. Audit results will be reviewed by the QAPI Committee monthly for three (3) months or until substantial compliance is achieved. LUXE AT WELLINGTON REHABILITATION CENTER THE 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 --- | --- | --- | --- | ---

K0345 SS = F | Continued from page 2 | K0345 | Continued from page 2 | | 9.6.1.3, 9.6.1.5, NFPA 70, NFPA 72 | | | | This STANDARD is NOT MET as evidenced by: | | | | Based on record review and staff interview, the facility failed to maintain their fire alarm system in accordance with NFPA 101, for 1 of 1 fire alarm system. This deficiency affects all residents and staff in facility. | | | | The findings included: | | | | On , at the following times, during record review with the Regional Maintenance Director, the following was revealed: | | | | 1. At 12:55 PM, documentation provided for the biennial smoke detector sensitivity testing, dated did not include the 7 of 7 duct smoke detectors. | | | | 2. At 1:00 PM, documentation provided for the annual duct detector differential pressure testing revealed that 7 of 7 duct detectors failed when tested. | | | | An interview was conducted with the Regional Maintenance Director concurrently with the record review and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on at 5:15 PM. | | | | NFPA 72 (2010 Edition) 10.18.3.1, 14.3.1, 14.4.2.2, 14.4.4.3.2, 14.6.2.1 | | | | NFPA 101 (2012 Edition) 4.6.12, 9.6, 19.1.1.13, 19.3.4.1 | | | | Photographic evidence obtained. | | |

K0353 SS = F | Sprinkler System - Maintenance and Testing | K0353 | The statements made on this Plan of Correction do not constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility's compliance with applicable federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated. | /2026 | CFR(s): NFPA 101 | | | | Sprinkler System - Maintenance and Testing | | | | Automatic sprinkler and standpipe systems are inspected, tested, and maintained in accordance with | | | LUXE AT WELLINGTON REHABILITATION CENTER THE 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 APPROPRIATE DEFICIENCY)

K0353 Continued from page 3 K0353 Continued from page 3 SS = F NFPA 25, Standard for the Inspection, Testing, and K0353 – Sprinkler System – Maintenance and Testing 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 THIS STANDARD IS NOT MET as evidenced by: Based on observations and staff interview, the facility failed to maintain their Automatic Fire Protection System (AFSS) in accordance with NFPA 101, for 1 of 1 AFSS. This deficiency affects all residents and staff in the facility. The findings included: On , at 3:00 PM, during the fire safety tour of the facility with the Regional Maintenance Director, it was observed in the Fire Riser Room that the spare sprinkler box was missing a spare concealed sprinkler wrench. An interview was conducted with the Regional Maintenance Director concurrently with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on at 5:15 PM. NFPA 13 (2010 Edition) 26.1 NFPA 25 (2011 Edition) 4.3.1, 5.1.1.2, 5.4.1.5, 5.4.1.6.1 NFPA 101 (2012 Edition) 2.1, 4.6.12, 9.7.1.1, 9.11.1, 19.3.5, 19.7.6 Immediate Corrective Action: A concealed sprinkler wrench was placed inside the spare sprinkler cabinet to ensure immediate accessibility in compliance with NFPA requirements. Identification of Other Residents Potentially Affected: All residents had the potential to be affected; however, based on observation, no residents were Measures to Prevent Recurrence: The Director of Maintenance was re educated on f ..regarding sprinkler system maintenance requirements, including ensuring spare sprinkler cabinets contain required tools and components at all times. Monitoring: The Director of Maintenance or designee will conduct daily checks for four (4) weeks, followed by weekly audits for two (2) months. Findings will be reported monthly to the QAPI Committee for three (3) months or until compliance is sustained.

K0521 K0521

K0524 The statements made on this Plan of Correction do not (2026 LUXE AT WELLINGTON REHABILITATION CENTER THE 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0521 SS = F Continued from page 4 CFR(s): NFPA 101 HVAC Heating, , and air conditioning shall comply with 9.2 and shall be installed in accordance with the manufacturer's specifications. 18.5.2.1, 19.5.2.1, 9.2 This STANDARD is NOT MET as evidenced by: Based on observations and staff interview, the facility failed to maintain their heating, , and air conditioning system (HVAC) in accordance with NFPA 101, for 2 of 2 soiled utility rooms. This deficiency affects all residents and staff in the facility. The findings included: On , at the following times, during the fire safety tour of the facility with the Regional Maintenance Director, the following was observed: 1. At 3:55 PM, the first floor Soiled Utility Room exhaust fan was not operational when tested. This was the only soiled utility room on the first floor. 2. At 4:50 PM, the second floor Soiled Utility Room exhaust fan was not operational when tested. This was the only soiled utility room on the second floor. An interview was conducted with the Regional Maintenance Director concurrently with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on at 5:15 PM. NFPA 91 (2010 Edition) 6.5.1, 10.2, 10.6.1 NFPA 101 (2012 Edition) 4.5.8, 4.6.1.2, 4.6.12, 9.2.1, 9.2.2, 19.1.1.3, 19.5.2.1

K0521 Continued from page 4 constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility's compliance with applicable federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated.

K0521 - HVAC Immediate Corrective Action: On , the Director of Maintenance assessed all exhaust fans. A licensed HVAC contractor repaired both soiled utility room exhaust fans on , restoring full functionality. Identification of Other Residents Potentially Affected: All residents had the potential to be affected; however, no residents were . All other HVAC systems were inspected and found compliant with NFPA 101. Measures to Prevent Recurrence: On , maintenance staff were re educated on HVAC preventive maintenance, including weekly inspection and documentation of exhaust fans and immediate reporting of deficiencies. Education in biohazard and soiled utility areas. Monitoring: The Director of Maintenance or designee will conduct weekly audits for four (4) weeks, followed by monthly audits for two (2) months. Audit results will be reviewed by the QAPI Committee monthly for three (3) months or until substantial compliance is determined.

K0920 SS = E Electrical Equipment - Power and Extens Bldg: 02 CFR(s): NFPA 101

K0920 The statements made on this Plan of Correction do not constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility's compliance with applicable /2026 106091 LUXE AT WELLINGTON REHABILITATION CENTER THE 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0920 SS = E Bldg. 02 Continued from page 5 Electrical Equipment - Power and Extension Power strips in a patient care vicinity are only used for components of movable patient-care-related electrical equipment (PCREE) assemblies that have been assembled by qualified personnel and meet the conditions of 10.2.3.6. Power strips in the patient care vicinity may not be used for non-PCREE (e.g., personal electronics), except in long-term care resident rooms that do not use PCREE. Power strips for PCREE meet UL 1363A or UL 60601-1. Power strips for non-PCREE meet UL 1363A or UL 60601-1. Power strips in non-patient care rooms of vicinity meet UL 1363. In non-patient care rooms, power strips meet other UL standards. Power strips are used with general extensions. Extension are not used as a substitute for fixed wiring of a structure. Extension used temporarily are removed immediately upon completion of the purpose for which it was installed and meets the conditions of 10.2.4. 10.2.3.6 (NFPA 99), 10.2.4 (NFPA 99), 400-8 (NFPA 70), 590.3(D) (NFPA 70). This STANDARD is NOT MET as evidenced by: Based on observations and staff interview, the facility failed to prevent the improper use of power strips, utilized in lieu of permanent wiring, in accordance with NFPA 99 and NFPA 101, of 8 sampled smoke compartments. This deficiency affects all residents and staff in the smoke compartments. The findings included: On , at the following times, during the fire safety tour of the facility with the Regional Maintenance Director, the following was observed: 1. At 3:10 PM, the Main Data Room had a power strip plugged into a power strip, which was plugged into a third power strip, creating a "daisy chain". A fourth power strip was plugged into a battery backup instead of directly into a wall receptacle. The four power strips and battery backup had various electronics plugged into them. 2. At 4:05 PM, -112, a private room, had a residential-style power strip plugged into a second residential-style power strip, creating a "daisy chain". This daisy chain wiring setup had various electronics plugged into it and was within six of

K0920 Continued from page 5 federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated.

K0920 – Electrical Equipment – Power and Extensions Immediate Corrective Action: All unauthorized power strips and battery backup devices were immediately removed from the main data room by the IT vendor. Unauthorized power strips identified in resident . 112 were also removed immediately. Identification of Other Residents Potentially Affected: All residents had the potential to be affected; however, no residents were . Measures to Prevent Recurrence: On .re education was provided to the Director of Maintenance and maintenance staff regarding the proper use of power strips and extension in accordance with NFPA 99 and NFPA 101. Monitoring: The Director of Maintenance or designee will complete daily audits for four (4) weeks, followed by weekly audits for two (2) months, to ensure continued compliance. Results will be reviewed monthly by the QAPI Committee for three (3) months or until sustained compliance is achieved. 106091 LUXE AT WELLINGTON REHABILITATION CENTER THE 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 PREFIX TAG CROSS-REFERENCED TO THE COMPLETION DATE

K0920 Continued from page 6 The resident was lying on the SS = E patient care area. The two daisy chained power strips was Bldg. 02 on the bed while one of the pillow. The second power strip was wrapped around the frame of the bed and wedged in between the frame and the mattress at the headboard. An interview was conducted with the Regional Maintenance Director concurrently with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on at 5:15 PM. NFPA 70 (2011 Edition) 110.3 (B), 400.5(A), 400.8 (1) NFPA 99 (2012 Edition) 10.1, 10.2.3.1.1, 10.2.3.6, 10.4.2.3 NFPA 101 (2012 Edition) 2.1, 9.1.2, 19.5.1.1, 19.5.1.3 Photographic evidence obtained. K0920 LUXE AT WELLINGTON REHABILITATION CENTER THE 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 PREFIX PREFIX TAG TAG APPROPRIATE DEFICIENCY) COMPLETION DATE

E0000 E0000 /2026 Initial Comments During the Fire & Life Safety Recertification survey, conducted on During the Fire & Life Safety Recertification survey, at Luxe at Wellington conducted on at Luxe at Wellington Rehabilitation Center (The), a nursing home, Emergency Rehabilitation Center (The), a nursing home, Emergency Preparedness was reviewed. Luxe at Wellington Preparedness was reviewed. Luxe at Wellington Rehabilitation Center (The) is not in compliance with Rehabilitation Center (The) is not in compliance with Emergency Preparedness per Code of Federal Regulations Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 483.73, Requirement for Long-Term Care (CFR) 42, Part 483.73, Requirement for Long-Term Care Facilities. Facilities.

E0032 E0032 /2026 SS = F SS = F /2026 Primary/Alternate Means for Communication Primary/Alternate Means for Communication CFR(s): 483.73(c)(3) The statements made on this Plan of Correction do not constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility’s compliance with applicable federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated. $403.748(c)(3), $416.54(c)(3), $418.113(c)(3), E0032 – Primary / Alternate Means for Communication $441.184(c)(3), $460.84(c)(3), $482.15(c)(3), Immediate Corrective Action: $483.73(c)(3), $483.475(c)(3), $484.102(c)(3), The satellite phone was removed from the facility’s $485.68(c)(3), $495.542(c)(3), $485.625(c)(3), listed alternate means of communication to ensure the $485.727(c)(3), $485.920(c)(3), $486.360(c)(3), emergency preparedness communication plan accurately $491.12(c)(3), $494.62(c)(3). reflects available and functional communication methods. (c) The [facility] must develop and maintain an Identification of Other Residents Potentially Affected: emergency preparedness communication plan that complies All current residents had the potential to be affected; with Federal, State and local laws and must be reviewed however, based on observation and review, no residents and updated at least every 2 years [annually for LTC were . facilities]. The communication plan must include all of the following: Measures to Prevent Recurrence: (3) Primary and alternate means for communicating with On . re education was provided to the the following: Administrator and Director of Maintenance regarding (i) [Facility] staff. compliance with federal, state, and local emergency (ii) Federal, State, tribal, regional, and local preparedness requirements. Education emergency management agencies. included the requirement that all primary and alternate *[For ICF/IIDs at $483.475(c)] (3) Primary and alternate means for communicating with the ICF/IID’s communication methods be accurately identified, staff, Federal, State, tribal, regional, and local maintained, and reviewed annually, and be available for emergency management agencies. inspection upon request. This REQUIREMENT is NOT MET as evidenced by: 106091 LUXE AT WELLINGTON REHABILITATION CENTER THE 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 PREFIX PREFIX TAG TAG APPROPRIATE DEFICIENCY)

E0032 E0032 SS = F Monitoring: The Administrator and Director of Maintenance will Continued from page 1 Based on record review and staff interview, the conduct an annual review and update of the emergency facility failed to ensure their alternate means of preparedness communication plan to ensure ongoing communication described in their Emergency Preparedness compliance. Findings will be reported to the Quality Program (EP), was available for inspection as required Assurance Performance Improvement (QAPI) Committee. in accordance with Code of Federal Regulations (CFR). The findings included: On __________ at 10:35 AM, during record review of the facility's EP with the Administrator, the facility listed a satellite phone as an alternate means of communication. The facility did not have a satellite phone on site and was unable to produce a satellite phone for inspection upon request. An interview was conducted with the Administrator concurrently with the record review and she acknowledged the findings. The findings were reviewed with the Administrator at the exit conference on at 5:15 PM. 42 CFR 483.73(c)(3) DATE Florida Department of Health 03/11/2026 LUXE AT WELLINGTON REHABILITATION CENTER THE 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414

K0000 INITIAL COMMENTS

K0000 The statements made on this Plan of Correction do not constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility's compliance with applicable federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated. /2026

K0324 SS = F Cooking Facilities CFR(s): NFPA 101 Cooking Facilities Cooking facilities shall be protected in accordance with 9.2.3, unless otherwise permitted by 19.3.2.5.2, 19.3.2.5.3, or 19.3.2.5.4. Commercial cooking operations shall be protected in accordance with NFPA 96 unless such installations are approved existing installations, which shall be permitted to be continued in service. 18.3.2.5.1 through 18.3.2.5.5, 19.3.2.5.1 through 19.3.2.5.5, 9.2.3. This LICENSURE REQUIREMENT IS NOT MET as evidenced by: Based on observation and staff interview, the facility failed to maintain their commercial cooking facility in accordance with NFPA 101, for 1 of 1 commercial cooking hood suppression system. This deficiency affects all residents and staff in the facility. The findings included:

K0324 /2026

K0324 – Cooking Facilities Immediate Corrective Action: On high temperature sealant was purchased. On 1 ... RTV 4500 food contact safe, ... all seams of the commercial kitchen hood suppression system were sealed using the approved food grade ... to ensure grease tight integrity. Identification of Other Residents Potentially Affected: All residents had the potential to be affected; however, based on observation, no residents were ... Measures to Prevent Recurrence: Office of Primary Care and Health Systems Management STATE FORM

K0324 SS = F Continued from page 1 K0324 Continued from page 1 On , at 3:30 PM, during the fire safety tour of the facility with the Maintenance Director, observations revealed the Kitchen commercial cooking hood suppression system seams were not sealed or otherwise made grease tight. An interview was conducted with the Regional Maintenance Director concurrently with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on at 5:15 PM. NFPA 96 (2021 Edition) 5.1.4, 10.2.6 NFPA 101 (2021 Edition) 2.1, 4.5.8, 4.6.12.1, 9.2.3, 19.3.2.5.1 Photographic evidence obtained. Class III

K0345 SS = F Fire Alarm System - Testing and Maintenance K0345 CFR(s): NFPA 101 Fire Alarm System - Testing and Maintenance Detection systems, where required, shall be in accordance with Section 9.6. Fire alarm systems required by this Code shall be installed, tested, and maintained in accordance with the applicable requirements of NFPA70 and NFPA72 unless otherwise permitted by 9.6.1.4. 18.3.4.1, 19.3.4.1, 9.6, and NFPA 70, and NFPA 72 This LICENSURE REQUIREMENT IS NOT MET as evidenced by: Based on record review and staff interview, the facility failed to maintain their fire alarm system in accordance with NFPA 101, for 1 of 1 fire alarm system. This deficiency affects all residents and staff in facility. The findings included: On , re education was provided to the appropriate Director of Maintenance and maintenance staff regarding maintenance of commercial cooking operations in accordance with NFPA 101. Education focused on ensuring hood suppression system seals remain grease tight and that any deficiencies are reported and corrected immediately. Monitoring: The Director of Maintenance or designee will conduct weekly audits for four (4) weeks, followed by monthly audits for two (2) months, to verify continued compliance. Audit results will be reviewed by the QAPI Committee monthly for three (3) months or until substantial compliance is achieved. The statements made on this Plan of Correction do not constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility's compliance with applicable federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated.

K0345 – Fire Alarm System – Testing and Maintenance Immediate Corrective Action: On , the fire alarm system vendor conducted sensitivity testing and duct detector differential pressure testing in accordance with code requirements. Identification of Other Residents Potentially Affected: All residents had the potential to be affected; however, no residents were , based on observation and system review. Measures to Prevent Recurrence:

K0345 SS = F Continued from page 2 On the following times, during record review with the Regional Maintenance Director, the following was revealed: 1. At 12:55 PM, documentation provided for the biennial smoke detector sensitivity testing, dated did not include the 7 dust smoke detectors. 2. At 1:00 PM, documentation provided for the annual duct detector differential pressure testing revealed that 7 of 7 duct detectors failed when tested. An interview was conducted with the Regional Maintenance Director concurrently with the record review and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on at 5:15 PM. NFPA 72 (2019 Edition) 7.7.1.1, 14.3.1, 14.4.3.2, 14.4.4.3.2, 14.6.2.1 NFPA 101 (2021 Edition) 4.6.12, 9.6, 19.1.1.1.3, 19.3.4.1 Photographic evidence obtained.

K0353 SS = F Sprinkler System - Maintenance and Testing CFR(s): NFPA 101 Sprinkler System - Maintenance and Testing Automatic sprinkler and standpipe systems are inspected, tested, and maintained in accordance with NFPA 25. All required documentation regarding the design of the fire protection system and the procedures for maintenance, inspection, and testing of the fire protection system shall be maintained of an approved, secured location for the life of the fire protection system. 19.7.6, 4.6.12, 4.6.12.1, 9.11 through 9.11.3.2, and NFPA 25 This LICENSURE REQUIREMENT IS NOT MET as evidenced by:

K0345 Continued from page 2 The Director of Maintenance was re educated on 1/ regarding NFPA 72 testing, inspection, and documentation requirements for fire alarm systems, including required testing intervals and vendor verification. Monitoring: The Director of Maintenance or designee will complete daily visual and documentation checks for four (4) weeks, followed by weekly reviews for two (2) months. Compliance reports will be reviewed by the QAPI Committee monthly for three (3) months or until substantial compliance is achieved.

K0353 The statements made on this Plan of Correction do not constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility's compliance with applicable federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated.

K0353 – Sprinkler System – Maintenance and Testing Immediate Corrective Action: A concealed sprinkler wrench was placed inside the spare sprinkler cabinet to ensure immediate accessibility in compliance with NFPA requirements. Identification of Other Residents Potentially Affected:

K0353 Continued from page 3 K0353 Continued from page 3 /2026 SS = F Based on observations and staff interview, the facility failed to maintain their Automatic Fire Sprinkler System (AFSS) in accordance with NFPA 101, for 1 of 1 AFSS. This deficiency affects all residents and staff in the facility. All residents had the potential to be affected; however, based on observation, no residents were The findings included: Measures to Prevent Recurrence: On __ at 3:00 PM, during the fire safety tour of the facility with the Regional Maintenance Director, it was observed in the Fire Riser Room that the spare sprinkler box was missing a spare concealed sprinkler wrench. The Director of Maintenance was re educated on ! regarding sprinkler system maintenance requirements, including ensuring spare sprinkler cabinets contain required tools and components at all times. An interview was conducted with the Regional Maintenance Director concurrently with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on at 5:15 PM. Monitoring: NFPA 1 (2021 Edition) 13.3.1.2, 13.3.3.3 The Director of Maintenance or designee will conduct daily checks for four (4) weeks, followed by weekly audits for two (2) months. Findings will be reported monthly to the QAPI Committee for three (3) months or until compliance is sustained. NFPA 13 (2019 Edition) 31.1 NFPA 25 (2020 Edition) 4.3.1, 5.1.1.2, 5.4.1.5.5 NFPA 101 (2021 Edition) 2.1, 4.6.12, 9.7.1.1, 9.11.1, 19.3.5, 19.7.6 Class III

K0521 HVAC K0521 The statements made on this Plan of Correction do not constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility's compliance with applicable federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated. SS = F CFR(s): NFPA 101 K0521 – HVAC HVAC Heating, __, and Air Conditioning Immediate Corrective Action: Heating, __, and air-conditioning shall comply with the provisions of Section 9.2 and shall be installed in accordance with the manufacturer's specifications, unless otherwise modified by 19.5.2.2. On __, the Director of Maintenance assessed all exhaust fans. A licensed HVAC contractor repaired both soiled utility room exhaust fans on __, restoring full functionality. 18.5.2.1, 19.5.2.1, 9.2 This LICENSURE REQUIREMENT IS NOT MET as evidenced by: Based on observations and staff interview, the facility failed to maintain their heating, __, and air Florida Department of Health PRINTED: 04/16/2026

K0521 Continued from page 4 K0521 Continued from page 4 SS = F conditioning system (HVAC) in accordance with NFPA 101, for 2 of 2 soiled utility rooms. This deficiency affects all residents and staff in the facility. The findings included: On , at the following times, during the fire safety tour of the facility with the Regional Maintenance Director, the following was observed: 1. At 3:55 PM, the first floor Soiled Utility Room exhaust fan was not operational when tested. This was the only soiled utility room on the first floor. 2. At 4:50 PM, the second floor Soiled Utility Room exhaust fan was not operational when tested. This was the only soiled utility room on the second floor. An interview was conducted with the Regional Maintenance Director concurrently with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on at 5:15 PM. NFPA 91 (2020 Edition) 6.5.1, 10.2, 10.6.1 NFPA 101 (2021 Edition) 4.5.8, 4.6.1.2, 4.6.12, 9.2.1, 9.2.2, 19.1.1.1.3, 19.5.2.1 Class III Identification of Other Residents Potentially Affected: All residents had the potential to be affected; however, no residents were .All other HVAC systems were inspected and found compliant with NFPA 101. Measures to Prevent Recurrence: On maintenance staff were educated on HVAC preventive maintenance, including weekly inspection and documentation of exhaust fans and immediate reporting of deficiencies. Education emphasized the importance of proper biohazard and soiled utility areas. in Monitoring: The Director of Maintenance or designee will conduct weekly audits for four (4) weeks, followed by monthly audits for two (2) months. Audit results will be reviewed by the QAPI Committee monthly for three (3) months or until substantial compliance is determined.

K0920 The statements made on this Plan of Correction do not constitute an admission or agreement with the alleged deficiencies. This Plan of Correction is submitted to demonstrate the facility's compliance with applicable federal, state, and local regulations. All alleged deficiencies cited have been or will be corrected by the dates indicated. /2026 SS = E Electrical Equipment - Power and Extens K0920 Bldg. 05 CFR(s): NFPA 99 Electrical Equipment - Power and Extension Power strips in a patient care vicinity are only used for components of movable patient-care-related electrical equipment (PCREE) assemblies that have been assembled by qualified personnel and meet the conditions of 10.2.3.6. Power strips in the patient care vicinity may not be used for non-PCREE (e.g., personal electronics), except in long-term care resident rooms that do not use PCREE. Power strips for PCREE meet UL 1363A or UL 60601-1. Power strips for K0920 – Electrical Equipment – Power and Extensions Immediate Corrective Action: All unauthorized power strips and battery backup devices were immediately removed from the main data Florida Department of Health PRINTED: 04/16/2026 03/11/2026 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 PREFIX PREFIX COMPLETION DATE

K0920 SS = E Bldg. 05 Continued from page 5 non-CPREE in the patient care rooms (outside of vicinity) meet UL 1363. In non-patient care rooms, power strips meet other UL standards. All power strips used with general precautions. Extension are not used as a substitute for fixed wiring of a structure. Extension used temporarily are removed immediately upon completion of the purpose for which it was installed and meets the conditions of 10.2.4. 10.2.3.6, 10.2.4, 10.5.2.3 (NFPA 99), NFPA 70 This LICENSURE REQUIREMENT is NOT MET as evidenced by: Based on observations and staff interview, the facility failed to prevent the improper use of power strips, utilized in lieu of permanent wiring, in accordance with NFPA 99 and NFPA 101, for 2 of 8 sampled smoke compartments. This deficiency affects all residents and staff in the smoke compartments. The findings included: On , at the following times, during the fire safety tour of the facility with the Regional Maintenance Director, the following was observed: 1. At 3:10 PM, the Main Data Room had a power strip plugged into a power strip, which was plugged into a third power strip, creating a "daisy chain". A fourth power strip was plugged into a battery backup instead of directly into a wall receptacle. The four power strips and battery backup had various electronics plugged into them. 2. At 4:05 PM. -112, a private room, had a residential-style power strip plugged into a second residential-style power strip, creating a "daisy chain". This daisy chain wiring setup had various electronics plugged into it and was within six of the patient care area. The resident was lying on the bed while one of the two daisy chained power strips was on bed next to the pillow. The second daisy chained power strip was wrapped around the frame of the bed and wedged in between the frame and the mattress at the headboard. An interview was conducted with the Regional Maintenance Director concurrently with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Regional Maintenance Director at the exit conference on K0920 Continued from page 5 room by the IT vendor. Unauthorized power strips identified in resident 112 were also removed immediately. Identification of Other Residents Potentially Affected: All residents had the potential to be affected; however, no residents were . Measures to Prevent Recurrence: On , re education was provided to the Director of Maintenance and maintenance staff regarding the proper use of power strips and extension in accordance with NFPA 99 and NFPA 101. Monitoring: The Director of Maintenance or designee will complete daily audits for four (4) weeks, followed by weekly audits for two (2) months to ensure continued compliance. Results will be reviewed monthly by the QAPI Committee for three (3) months or until sustained compliance is achieved. Florida Department of Health PRINTED: 04/16/2026 10330 NUVISTA AVENUE, WELLINGTON, Florida, 33414 APPROPRIATE DEFICIENCY)

K0920 Continued from page 6 K0920 SS = E at 5:15 PM. Bldg. 05 NFPA 1 (2021 Edition) 11.1.2.1, 11.1.4.2 NFPA 70 (2020 Edition) 110.3 (B), 400.5(A), 400.12 (1) NFPA 99 (2021 Edition) 10.1, 10.2.3.1.1, 10.2.3.6, 10.4.2.3 NFPA 101 (2021 Edition) 2.1, 9.1.2, 19.5.1.1, 19.5.1.3 Photographic evidence obtained. Class III