Inspection·May 6, 2026

K0000 Bldg. 01 INITIAL COMMENTS An unannounced Fire & Life Safety Recertification survey was conducted on Center and Rehab, a nursing home in Lauderdale Lakes, Florida. Palms Care Center and Rehab 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: 1977 Existing NFPA 220 Construction Type: II (000) Number of beds: 120 Census: 113 The following is a description of the noncompliance. Sprinkler System - Maintenance and Testing

K0000

K0353 SS = F Bldg. 01 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, 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

K0353 On , the facility completed an inspection of the riser water flow device and tamper switch, as well as the two tamper switches connected to the fire line backflow system. The Maintenance Director reviewed the fire inspection report to identify if any other mandatory testing requirements were missed. Corrective action was taken as needed. The Nursing Home Administrator educated the Maintenance Director regarding compliance with the Automatic Fire Sprinkler System (AFSS) requirements in accordance with NFPA 101 on The facility has with United Fire to ensure ongoing compliance on . The Director of Maintenance or designee will monitor compliance with the Quarterly Automatic Fire Sprinkler System requirements and report findings at --- | --- | --- | --- --- | --- PALMS CARE CENTER AND REHAB | 3370 NW 47TH TERRACE, LAUDERDALE LAKES, Florida, 33319 --- | --- | --- | --- | ---

K0353 SS = F Bldg. 01 | Continued from page 1 Provide from 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 record review 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 in the facility. The findings included: On at 12:30 PM, during record review with the Maintenance Director, it was revealed that no documentation could be provided for the quarterly inspection and semi-annual testing of the riser waterflow device and tamper switch as well as the two tamper switches connected to the fire-line backflow. An interview was conducted with the Maintenance Director concurrently with the record review and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 4:00 PM. NFPA 13 (2010 Edition) 26.1 NFPA 25 (2011 Edition) 4.3.1, 5.1.1.2, 13.1.1.2 NFPA 101 (2012 Edition) 2.1, 4.6.12, 9.7.11, 9.11.1, 19.3.5, 19.7.6 | K0353 | Continued from page 1 the monthly QAPI Committee meeting monthly to ensure substantial compliance is maintained. |

K0918 SS = F Bldg. 01 | Electrical Systems - Essential Electric 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 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. | K0918 | 1. The facility conducted an audit of the Essential Electrical System (EES) maintenance records and verified completion of documentation for weekly battery voltage checks and monthly specific gravity testing for the generator battery in accordance with NFPA 99 and NFPA 110 requirements on 2. The Maintenance Director audited generator maintenance and testing records to identify if any additional required documentation or testing requirements were missed. Corrective action was taken as needed by 3. The Administrator educated the Maintenance Director regarding compliance with Essential | PALMS CARE CENTER AND REHAB 3370 NW 47TH TERRACE, LAUDERDALE LAKES, Florida, 33319 --- | --- | --- | --- | ---

K0918 SS = F Bldg. 01 | Continued from page 2 | K0918 | Continued from page 2 | | Generator sets are inspected weekly, exercised under load 30 minutes 12 times a year in 20-40 day intervals, and exercised under load 4 times a year for 4 continuous hours. Scheduled test every 36 months for 4 conditions include a complete simulated 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 STANDARD is NOT met as evidenced by: | | | | Based on record review and staff interview, the facility failed to maintain the Essential Electrical System (EES) in accordance with NFPA 99, for 1 of 1 generator. This deficiency affects all residents in the facility. | | | | The findings included: | | | | On , at the following times, during record review with the Maintenance Director, the following was revealed: | | | | 1. At 1:45 PM, no documentation was provided for the weekly check of the battery voltage for the generator battery, prior to . | | | | 2. At 1:50 PM, no documentation was provided for the monthly specific gravity testing of the generator sealed battery, prior to . | | | | An interview was conducted with the Maintenance Director concurrently with the record review and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on 4:00 PM. at | | | | | Electrical System (EES) maintenance, testing, documentation, and monitoring requirements in accordance with NFPA 99 and NFPA 110 regulations on | | | | | 4. The Director of Maintenance or designee will monitor compliance with generator maintenance and testing requirements weekly and report findings at the monthly QAPI Committee meeting monthly to ensure substantial compliance is maintained. | | | 3370 NW 47TH TERRACE, LAUDERDALE LAKES, Florida, 33319 CROSS-REFERENCED TO THE DATE

K0918 Continued from page 3 K0918 SS = F Bldg. 01 NFPA 99 (2012 Edition) 6.7.4.1.1.3, 6.7.4.1.1.5, 6.7.4.1.2.3, 6.7.4.2 NFPA 101 (2012 Edition) 2.1, 9.1.3.1, 19.5.1.1 NFPA 110 (2010 Edition) 8.1.1, 8.3.6.1, 8.4.1, 8.4.2, 8.5 PALMS CARE CENTER AND REHAB 3370 NW 47TH TERRACE , LAUDERDALE LAKES, Florida, 33319

E0000 Initial Comments During the Fire & Life Safety Recertification survey, conducted on at Palms Care Center and Rehab, a nursing home, Emergency Preparedness was reviewed. E0000

E0031 SS = F Emergency Officials Contact Information CFR(s): 483.73(c)(2) $403.748(c)(2), $416.54(c)(2), 5418.113(c)(2), $441.184(c)(2), $460.84(c)(2), $482.15(c)(2), $483.73(c) $483.475(c)(2), $484.102(c)(2), $485.68(c)(2), $485.542(c)(2), $485.625(c)(2), $485.727(c)(2), $485.920(c)(2), $486.360(c)(2), $491.12(c)(2), $494.62(c)(2). (c) [The facility] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following: (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. *For LTC Facilities at §483.73(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) The State Licensing and Certification Agency. E0031 On the facility updated the Emergency Preparedness Program (EPP) communication plan to reflect emergency official contact information for the State Licensing and Certification Agency and the State Long-Term Care Ombudsman contact information. An audit was conducted to ensure all required elements of the facility's Emergency Preparedness Program Communication Plan were in compliance with federal regulations. Corrective action was taken as needed by On Nursing Home Administrator completed education and training on Emergency Preparedness- with focus on compliance of E0031 and maintaining an Emergency Preparedness communication plan that complies with federal, state, and local laws and regulations. The Nursing Home Administrator or designee will monitor compliance with the facility communication plan and report findings at the monthly QAPI Committee meeting monthly to ensure substantial compliance is maintained. PALMS CARE CENTER AND REHAB 3370 NW 47TH TERRACE, LAUDERDALE LAKES, Florida, 33319

E0031 SS = F Continued from page 1

E0031 (iii) The Office of the State Long-Term Care Ombudsman, ( ) Other sources of assistance. [For ICF/IIDs at §483.475(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. (iii) The State Licensing and Certification Agency. ( ) The State Protection and Advocacy Agency. This REQUIREMENT is NOT MET as evidenced by: Based on record review and staff interview, the facility failed to incorporate all the required elements in their communication plan for their Emergency Preparedness Program (EP), in accordance with the Code of Federal Regulations (CFR). The findings included: On , at 11:00 AM, during record review of the facility's EP with the Administrator, there was no emergency official contact information for the State Licensing and Certification Agency and the State Long-Term Care Ombudsman contact information documented in the plan. An interview was conducted with the Administrator concurrently with the record review and she acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on 4:00 PM. at 42 CFR 483.73(c)(2)(ii, iii) 3370 NW 47TH TERRACE , LAUDERDALE LAKES, Florida, 33319 CROSS-REFERENCED TO THE COMPLETION DATE

K0000 Bldg. 05 INITIAL COMMENTS K0000 An unannounced Fire & Life Safety re-licensure survey was conducted on Lakes, Florida in accordance with National Fire Protection Association (NFPA) 1 and 101 (2021 Edition) and applicable requirements of Florida 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.

K0353 SS = F Bldg. 05 Sprinkler System - Maintenance and Testing K0353 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 at 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: Based on record review and staff interview, the facility failed to maintain its Automatic Fire Sprinkler System (AFSS) in accordance with NFPA 101, for 1 of 1 AFSS. This deficiency affects all residents in the facility. The findings included: On the facility completed an inspection of the riser water flow device and tamper switch, as well as the two tamper switches connected to the fire line backflow system. The Maintenance Director reviewed the fire inspection report to identify if any other mandatory testing requirements were missed. Corrective action was taken as needed. The Nursing Home Administrator educated the Maintenance Director regarding compliance with the Automatic Fire Sprinkler System (AFSS) requirements in accordance with NFPA 101 on facility has with United Fire to ensure ongoing compliance on The Director of Maintenance or designee will monitor compliance with the Quarterly Automatic Fire Sprinkler System requirements and report findings at the monthly QAPI Committee meeting monthly to ensure substantial compliance is maintained. Office of Primary Care and Health Systems Management PALMS CARE CENTER AND REHAB 3370 NW 47TH TERRACE, LAUDERDALE LAKES, Florida, 33319 --- | --- | --- | --- | ---

K0353 SS = F Bldg. 05 | Continued from page 1 On , at 12:30 PM, during record review with the Maintenance Director, it was revealed that no documentation could be provided for the quarterly inspection and semi-annual testing of the riser waterflow device and tamper switch as well as the two tamper switches connected to the fire-line backflow. An interview was conducted with the Maintenance Director concurrently with the record review and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 4:00 PM. NFPA 1 (2021 Edition) 13.3.1.2, 13.3.3.2 NFPA 13 (2019 Edition) 31.1 NFPA 25 (2020 Edition) 4.3.1, 5.1.1.2, 5.2.4, 13.1.1.2, 13.2.4, 13.2.4.1, 13.2.4.4.2, 13.2.4.5 NFPA 101 (2021 Edition) 2.1, 4.6.12, 9.7.1.1, 9.11.1, 19.3.5, 19.7.6 Class III | K0353 | | |

K0918 SS = F Bldg. 05 | Electrical Systems - Essential Electric Syste CFR(s): NFPA 99 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 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 four continuous hours. Scheduled test under load conditions includes a complete simulated 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 | K0918 | 1. The facility conducted an audit of the Essential Electrical System (EES) maintenance records and verified completion of documentation for weekly battery voltage checks and monthly specific gravity testing for the generator battery in accordance with NFPA 99 and NFPA 110 requirements. 2. The Maintenance Director audited generator maintenance and testing records to identify if any additional required documentation or testing requirements were missed. Corrective action was taken as needed by. 3. The Administrator educated the Maintenance Director regarding compliance with Essential Electrical System (EES) maintenance, testing, documentation, and monitoring requirements in accordance with NFPA 99 and NFPA 110 regulations on . 4. The Director of Maintenance or designee will monitor compliance with generator maintenance and testing requirements weekly and report findings at the monthly QAPI Committee meeting to ensure substantial compliance is maintained. | | STATE FORM 1098096 05/06/2026 PALMS CARE CENTER AND REHAB 3370 NW 47TH TERRACE, LAUDERDALE LAKES, Florida, 33319 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0918 SS = F Bldg. 05 Continued from page 2 annually, and a program 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. 6.9.1, 6.9.2, 6.9.3, 6.9.4, 6.10.18, 6.11 through 6.11.4.4 (NFPA 99), NFPA 110, NFPA 111, NFPA 70 This LICENSURE REQUIREMENT is NOT MET as evidenced by: Based on record review and staff interview, the facility failed to maintain the Essential Electrical System (EES) in accordance with NFPA 99, for 1 of 1 generator. This deficiency affects all residents in the facility. The findings included: On , at the following times, during record review with the Maintenance Director, the following was revealed: 1. At 1:45 PM, no documentation was provided for the weekly check of the battery voltage for the generator battery, prior to 2. At 1:50 PM, no documentation was provided for the monthly specific gravity testing of the generator sealed battery, prior to An interview was conducted with the Maintenance Director concurrently with the record review and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on 4:00 PM. at NFPA 99 (2021 Edition) 6.7.4.1.1.3, 6.7.4.1.1.5, 6.7.4.1.2.3, 6.7.4.2 NFPA 101 (2021 Edition) 2.1, 9.1.3.1, 19.5.1.1 NFPA 110 (2019 Edition) 8.1.1, 8.3.6.1, 8.4.1, 8.4.2, 8.5 STATE FORM 1098096 05/06/2026 PALMS CARE CENTER AND REHAB 3370 NW 47TH TERRACE , LAUDERDALE LAKES, Florida, 33319 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0918 SS = F Bldg. 05 Continued from page 3 Class III

K0918 STATE FORM