Inspection·December 6, 2023

Agency for Health Care Administration PRINTED: 12/12/2023 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 100603 R 12/06/2023 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) (X6) COMPLETE DATE (K 000) INITIAL COMMENTS (K 000) An unannounced Fire & Life Safety revisit survey was conducted on 12/06/2023 at Broward Nursing & Rehabilitation Center, a nursing home in Ft. Lauderdale, Florida. This was a follow-up to the annual Fire & Life Safety survey completed on 10/26/2023. All previously cited Fire & Life Safety deficiencies were corrected. There were no deficiencies found at the time of the revisit. AHCA Form 3020-0001 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X8) DATE Electronically Signed 12/11/23 STATE FORM 6809 88V322 If continuation sheet 1 of 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION PRINTED: 12/12/2023 FORM APPROVED OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING 01 - MAIN FED (X3) DATE SURVEY COMPLETED 105083 R 12/06/2023 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 000] INITIAL COMMENTS [K 000] An unannounced Fire & Life Safety revisit survey was conducted on 12/06/2023 at Broward Nursing & Rehabilitation Center, a nursing home in Ft. Lauderdale, Florida. This was a follow-up to the annual Fire & Life Safety survey completed on 10/26/2023. All previously cited Fire & Life Safety deficiencies were corrected. There were no deficiencies found at the time of the revisit. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 12/11/2023 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:8BV322 Facility ID: 106603 If continuation sheet Page 1 of 1