Inspection·October 26, 2023

K 353 NFPA 101 Sprinkler System - Maintenance and SS=D Testing K 353 11/26/23 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 AHCA Form 3020-0001 LABORATORY DIRECTOR(S) OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 11/15/23 STATE FORM 6809 88V321 If continuation sheet 1 of 6 Agency for Health Care Administration PRINTED: 11/16/2023 FORM APPROVED STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 100603 (X2) MULTIPLE CONSTRUCTION A. BUILDING: 05 - MAIN LIC B. WING __________ (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER BROWARD NURSING & REHABILITATION CENTER STREET ADDRESS, CITY, STATE, ZIP CODE 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 | (X4) ID PREFIX TAG | SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) | ID PREFIX TAG | PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) | (X5) 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 their automatic fire sprinkler system in accordance with NFPA 101. The findings included: On 10/26/2023 between 10:00 AM and 12:30 PM during facility tour with the Director of Maintenance, the hydraulic calculation information sign was not attached to the sprinkler riser. An interview was conducted with the Director of Maintenance concurrent with the observations and confirmed the findings. NFPA 101 (2018) 19.7.6, 4.6.12, 4.6.12.1 NFPA 25 (2017) 5.2.5, 5.2.5.1 Class III | K 353 | K353 Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because required. The facility contracted sprinkler company, Wayne Automatic Fire Sprinkler, Inc. came to the facility October 31, 2023 to assess the sprinkler system and installed the hydraulic calculation information sign. The sign was attached to the sprinkler riser and was labeled a pipe schedule system. The maintenance department was re-educated by the Administrator on ensuring that the sign is attached to the sprinkler riser on October 31, 2023 and November 10, 2023. A new process was implemented on 11/1/2023 of maintenance rounds to include checking that the sign is attached to the sprinkler riser. The Maintenance Director/Designee will conduct random daily observation audits x4 weeks to include checking that the sign labeled as a pipe schedule system is attached to the sprinkler riser. The results of this audit will be reviewed at the | | AHCA Form 3020-0001 STATE FORM notes 8BV321 if continuation sheet, 2 of 6 Agency for Health Care Administration PRINTED: 11/16/2023 FORM APPROVED STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION IDENTIFICATION NUMBER: A. BUILDING: 05 - MAIN LIC B. WING __________ (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER BROWARD NURSING & REHABILITATION CENTER STREET ADDRESS, CITY, STATE, ZIP CODE 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X6) COMPLETE DATE

K 353 Continued From page 2 K 353 monthly QAA meeting until compliance has been determined.

K 741 NFPA 101 Smoking Regulations K 741 SS=D 11/26/23 Smoking Regulations Smoking regulations shall be adopted and shall include not less than the following provisions: (1) Smoking shall be prohibited in any room, ward, or compartment where flammable liquids, combustible gases, or oxygen is used or stored and in any other hazardous location, and such area shall be posted with signs that read NO SMOKING or shall be posted with the international symbol for no smoking. (2) In health care occupancies where smoking is prohibited and signs are prominently placed at all major entrances, secondary signs with language that prohibits smoking shall not be required. (3) Smoking by patients classified as not responsible shall be prohibited. (4) The requirement of 18.7.4(3) shall not apply where the patient is under direct supervision. (5) Ashtrays of noncombustible material and safe design shall be provided in all areas where smoking is permitted. (6) Metal containers with self-closing cover devices into which ashtrays can be emptied shall be readily available to all areas where smoking is permitted. 18.7.4, 19.7.4 (Note smoking tower disposal receptacles are not ashtrays) This Statute or Rule is not met as evidenced by: Based on observation and interview, the facility failed to manage smoking in accordance with NFPA 101.

K741 Preparation and/or execution of this plan does not constitute admission or AHCA Form 3020-0001 STATE FORM notes BBV321 if continuation sheet, 3 of 6 Agency for Health Care Administration PRINTED: 11/16/2023 FORM APPROVED STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING: 05 - MAIN LIC B. WING ______ (X3) DATE SURVEY COMPLETED 10/26/2023 100603 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE BROWARD NURSING & REHABILITATION CENTER 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL TAG REGULATORY OR LSC IDENTIFYING INFORMATION) ID PROVIDER'S PLAN OF CORRECTION PREFIX (EACH CORRECTIVE ACTION SHOULD BE TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X6) COMPLETE DATE

K 741 Continued From page 3 K 741 The findings included: On 10/26/2023 between 10:00 AM and 12:30 PM during facility tour with the Director of Maintenance, approximately 20-25 cigarette butts were found on the ground in the smoking patio area. An interview was conducted with the Director of Maintenance concurrent with the observations and confirmed the findings. NFPA 101 (2018 Edition) 19.7.4 Class III agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because required. The Cigarette butts found in the courtyard area on the ground were swept up and disposed into a red metal container with a self closing lid by the maintenance staff person on 10/26/2023. The maintenance staff and other assigned courtyard staff were re-educated to sweep cigarette butts daily and as needed on October 27, 30, 31, and November 10, 2023. A new process was implemented on November 1, 2023 for monthly maintenance rounds to include having staff sweep the courtyard daily and as needed. The Maintenance Director/Designee will conduct random daily observation audits x 4 weeks to include checking for cigarette butts in the courtyard area. The results of the audit will be reviewed at the monthly QAA meeting until compliance has been determined. 11/26/23

K 920 NFPA 99 Electrical Equipment - Power Cords and SS=D Extens Electrical Equipment - Power Cords and Extension Cords Power strips in a patient care vicinity are only K 920 11/26/23 AHCA Form 3020-0001 STATE FORM notes 8BV321 If continuation sheet 4 of 6 Agency for Health Care Administration PRINTED: 11/16/2023 FORM APPROVED STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 100603 (X2) MULTIPLE CONSTRUCTION A. BUILDING: 05 - MAIN LIC B. WING __ (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER BROWARD NURSING & REHABILITATION CENTER STREET ADDRESS, CITY, STATE, ZIP CODE 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE

K 920 Continued From page 4 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 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 are used with general precautions. Extension cords are not used as a substitute for fixed wiring of a structure. Extension cords 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 Statute or Rule is not met as evidenced by: Based on observation and staff interview, the facility failed to properly maintain the electrical system in accordance with NFPA 1. The findings included: On 10/26/2023 between 10:00 AM and 12:30 PM during facility tour with the Director of Maintenance, the following were identified: 1. Fish tank located in the main lobby of the first floor was plugged into a 3-prong adapter which was connected to a power strip and not directly into the wall. 2. Fish tank located in the east wing dining room on the second floor was connected to an

K 920 Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because required. 1. The three prong adapter which was connected to the power strip located behind the fish tank in the first floor lobby were removed by the Maintenance Director. AHCA Form 3020-0001 STATE FORM notes 8BV321 if continuation sheet, 5 of 6 Agency for Health Care Administration PRINTED: 11/16/2023 FORM APPROVED STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 100603 (X2) MULTIPLE CONSTRUCTION A. BUILDING: 05 - MAIN LIC B. WING: (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER BROWARD NURSING & REHABILITATION CENTER STREET ADDRESS, CITY, STATE, ZIP CODE 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X6) COMPLETE DATE

K 920 Continued From page 5 extension cord and not directly into the wall. An interview was conducted with the Director of Maintenance concurrent with the observations and confirmed the findings. NFPA 1 (2018 Edition) 11.1.2 through 11.1.5.6 NFPA 70 (2017 Edition) 400.12 Class III

K 920 2. The extension cord located on the east wing dining room behind the fish tank on the second floor was removed by the Maintenance Director. The maintenance department was re-educated on not using power strips and extension cords in the facility by the Administrator on October 27, 30, 31 and November 10, 2023. A new process was implemented on 10/30/2023 of maintenance rounds to include checking for power strips and extension cord use. The Maintenance Director/Designee will conduct random weekly observation audits x 4 weeks to include checking for power strips and extension cord use. The results of this audit will be reviewed in the monthly QAA meeting until compliance has been determined. AHCA Form 3020-0001 STATE FORM notes 8BV321 If continuation sheet, 6 of 6 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PRINTED: 11/16/2023 FORM APPROVED OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION ID PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING 01 - MAIN FED (X3) DATE SURVEY COMPLETED 105083 B. WING 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE BROWARD NURSING & REHABILITATION CENTER 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PREFIX TAG PREFIX TAG PROVIDER'S PLAN OF CORRECTION (X5) COMPLETION (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) DATE

K 000 INITIAL COMMENTS K 000 An unannounced Fire & Life Safety recertification survey was conducted 10/26/2023 at Broward Nursing and Rehabilitation Center, a nursing home in Ft. Lauderdale, Florida. Broward Nursing and Rehabilitation Center is not 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: 1968 Existing NFPA 220 Construction Type: II (111) Number of beds: 198 Census: 153 The following is a description of the deficiencies found at the time of the visit:

K 353 Sprinkler System - Maintenance and Testing K 353 11/26/23 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 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 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 11/15/2023 Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date of survey these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:8BV321 Facility ID: 106603 If continuation sheet Page 1 of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PRINTED: 11/16/2023 FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 105083 (X2) MULTIPLE CONSTRUCTION A. BUILDING 01 - MAIN FED (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER BROWARD NURSING & REHABILITATION CENTER STREET ADDRESS, CITY, STATE, ZIP CODE 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETION DATE

K 353 Continued From page 1 any non-required or partial automatic sprinkler system. 9.7.5, 9.7.7, 9.7.8, and NFPA 25 This REQUIREMENT is not met as evidenced by: Based on observation and staff interview, the facility failed to maintain their automatic fire sprinkler system in accordance with NFPA 101. The findings included: On 10/26/2023 between 10:00 AM and 12:30 PM during facility tour with the Director of Maintenance, the hydraulic calculation information sign was not attached to the sprinkler riser. An interview was conducted with the Director of Maintenance concerning the observations and confirmed the findings. NFPA 101 (2012) 19.7.6, 4.6.12, 4.6.12.1 NFPA 25 (2011) 5.2.6

K 353

K353 Preparation and/or execution of this plan does not constitute admission or agreement of the provision of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because required. The facility contracted sprinkler company, Wayne Automatic Fire Sprinkler, Inc. came to the facility October 31, 2023 to assess the sprinkler system and installed the hydraulic calculation information sign. The sign was attached to the sprinkler riser and was labeled a pipe schedule system. The maintenance department was re-educated by the Administrator on ensuring that the sign is attached to the sprinkler riser on October 31, 2023 and November 10, 2023. A new process was implemented on 11/1/2023 of maintenance rounds to include checking that the sign is attached to the sprinkler riser. The Maintenance Director/Designee will conduct random daily observation audits x4 weeks to include checking that the sign labeled as a pipe schedule system is FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:8BV321 Facility ID: 106063 If continuation sheet Page 2 of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINTED: 11/16/2023 CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 105083 (X2) MULTIPLE CONSTRUCTION A. BUILDING 01 - MAIN FED (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER BROWARD NURSING & REHABILITATION CENTER STREET ADDRESS, CITY, STATE, ZIP CODE 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY?) (X5) COMPLETION DATE

K 353 Continued From page 2 K 353 attached to the sprinkler riser. The results of this audit will be reviewed at the monthly QAA meeting until compliance has been determined.

K 741 Smoking Regulations SS-D CFR(s): NFPA 101 K 741 11/26/23 Smoking Regulations Smoking regulations shall be adopted and shall include not less than the following provisions: (1) Smoking shall be prohibited in any room, ward, or compartment where flammable liquids, combustible gases, or oxygen is used or stored and in any other hazardous location, and such area shall be posted with signs that read NO SMOKING or shall be posted with the international symbol for no smoking. (2) In health care occupancies where smoking is prohibited and signs are prominently placed at all major entrances, secondary signs with language that prohibits smoking shall not be required. (3) Smoking by patients classified as not responsible shall be prohibited. (4) The requirement of 18.7.4(3) shall not apply where the patient is under direct supervision. (5) Ashtrays of noncombustible material and safe design shall be provided in all areas where smoking is permitted. (6) Metal containers with self-closing cover devices into which ashtrays can be emptied shall be readily available to all areas where smoking is permitted. 18.7.4, 19.7.4 This REQUIREMENT is not met as evidenced by: Based on observation and interview, the facility failed to manage smoking in accordance with

K741 FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:8BV321 Facility ID: 100603 If continuation sheet Page 3 of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PRINTED: 11/16/2023 FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING 01 - MAIN FED (X3) DATE SURVEY COMPLETED 105083 B. WING 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE BROWARD NURSING & REHABILITATION CENTER 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY?) (X5) COMPLETION DATE

K 741 Continued From page 3 NFPA 101.

K 741 NFPA 101 (2012 Edition) 19.7.4 Preparation and/or execution of this plan do not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because required. The findings included: On 10/26/2023 between 10:00 AM and 12:30 PM during facility tour with the Director of Maintenance, approximately 20-25 cigarette butts were found on the ground in the smoking patio area. The Cigarette butts found in the courtyard area on the ground were swept up and disposed into a red metal container with a self closing lid by the maintenance staff person on 10/26/2023. An interview was conducted with the Director of Maintenance concurrent with the observations and confirmed the findings. The maintenance staff and other assigned courtyard staff were re-educated to sweep cigarette butts daily and as needed on October 27, 30, 31, and November 10, 2023. A new process was implemented on November 1, 2023 for monthly maintenance rounds to include having staff sweep the courtyard daily and as needed. The Maintenance Director/Designee will conduct random daily observation audits x 4 weeks to include checking for cigarette butts in the courtyard area. The results of the audit will be reviewed at the monthly QAA meeting until compliance has been determined. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:8BV321 Facility ID: 100603 If continuation sheet Page 4 of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINTED: 11/16/2023 CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING ______ B. WING ______ (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER BROWARD NURSING & REHABILITATION CENTER STREET ADDRESS, CITY, STATE, ZIP CODE 1330 S ANDREWS AVE FORT LAUDERDALE, FL 33316 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL TAG REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETION DATE

E 000 Initial Comments

E 000 During the Fire & Life Safety survey conducted on 10/26/2023 at Broward Nursing and Rehabilitation Center, a nursing home, Emergency Preparedness was reviewed. Broward Nursing and Rehabilitation Center is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 483.73, requirement for Long-Term Care Facilities. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE Electronically Signed TITLE 11/15/2023 Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:8BV321 Facility ID: 106603 If continuation sheet Page 1 of 1