Inspection·December 4, 2023

DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PRINTED: 12/12/2023 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 __________ B. WING __________ (X3) DATE SURVEY COMPLETED R-C 12/04/2023 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 [F 000] INITIAL COMMENTS [F 000] An unannounced revisit to the Recertification and complaint #2023011829 survey, was conducted on 12/04/23 at Broward Nursing and Rehabilitation Center. The facility is in compliance with 42 CFR Part 483, Requirements for Long Term Care Facilities. Previously cited deficiencies were found corrected. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE Electronically Signed TITLE 12/11/2023 (X6) DATE 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:8BV312 Facility ID: 106603 If continuation sheet Page 1 of 1 Agency for Health Care Administration PRINTED: 12/13/2023 FORM APPROVED STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING: __________ (X3) DATE SURVEY COMPLETED 100603 B. WING ________ R-C 12/04/2023 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 PROVIDER'S PLAN OF CORRECTION PREFIX (EACH CORRECTIVE ACTION SHOULD BE TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X6) COMPLETE DATE (N 000) INITIAL COMMENTS (N 000) An unannounced revisit to the Relicensure and complaint #2023011829 survey, was conducted on 12/04/23 at Broward Nursing and Rehabilitation Center. The previously cited deficiencies were found corrected at the time of the survey. AHCA Form 3020-0001 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X8) DATE Electronically Signed 12/11/23 STATE FORM 6809 88V312 If continuation sheet 1 of 1