Inspection·February 12, 2025

K 324 NFPA 101 Cooking Facilities SS=D K 324 3/13/25 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 Statute or Rule is not met as evidenced by: Based on observations and staff interviews, the facility failed to maintain the commercial kitchen in accordance with NFPA 101. 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 AHCA Form 3020-0001 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 03/07/25 STATE FORM 6899 ZXVE21 If continuation sheet 1 of 3 Agency for Health Care Administration PRINTED: 03/11/2025 FORM APPROVED STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY IDENTIFICATION NUMBER: A. BUILDING: 05 - MAIN LIC COMPLETED 02/12/2025 100603 B. WING __ 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 (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY)

K 324 Continued From page 1 K 324 on the statement of deficiencies. This plan of correction is prepared and/or executed solely because required.

K324 1. A restraining device was installed on the gas stove to limit the movement of the appliance. 2. The maintenance director/designee will conduct monthly inspection to ensure the restraining device is intact and mounted to the wall as part of the facility preventative maintenance program. 3. The maintenance director/designee will conduct weekly (x4 weeks) inspections on the restraining device to ensure they are intact. The results of this audit will be reviewed at the monthly QA meeting until compliance has been determined. The findings included: On 2/11/2025 at 1:30 p.m. while touring the dietary kitchen with the Director of Maintenance, it was observed that the gas stove mounted on casters failed to have a restraining device installed to limit the movement of the appliance. An interview was conducted with the Director of Maintenance concurrent with the observations and he acknowledged the findings. These findings were reviewed with the Director of Maintenance and the Administrator during the exit conference on 02/12/25 at 1:30 PM. NFPA 101 (2021 edition) 19.3.2.5.1, 9.2.3 NFPA 96 (2011 edition) 12.1.2.2 NFPA 54 (2012 edition) 10.12.6 Class III

K 353 NFPA 101 Sprinkler System - Maintenance and K 353 3/13/25 SS=D Testing 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 Statute or Rule is not met as evidenced by: AHCA Form 3020-0001 STATE FORM ess9 ZXVE21 if continuation sheet 2 of 3 Agency for Health Care Administration 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 02/12/2025 PRINTED: 03/11/2025 FORM APPROVED 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 PRECEDING 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 2 K 353 Based on observations and staff interviews, the facility failed to maintain their automatic fire sprinkler system (AFSS) in accordance with NFPA 101. The findings included: The following observations were made while conducting facility tour with the Director of Maintenance: 1. On 02/11/25 at 11:30 AM, on the second floor South Handler Electrical Room there was 1 of 1 sprinkler that had an electrical conduit pipe resting on the sprinkler deflector. 2. On 02/12/25 at 11:45 AM, the outside oxygen storage area had 1 of 1 upright sprinkler that had the deflector resting up on the ceiling. An interview was conducted with the Director of Maintenance concurrent with the observations and he acknowledged the findings. These findings were reviewed with the Director of Maintenance and the Administrator during the exit conference on 02/12/25 at 1:30 PM. Photographic evidence obtained. NFPA 101 (2021 edition) 19.3.5.8, 9.7, 9.7.1.1 (1) NFPA 13 (2019 edition) 10.2.6.1.1.1 Class III Preparation and/or execution of this plan does not constitute admission or agreement with 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.

K353 1. The sprinkler in the second floor South Handler Electrical Room was adjusted, so that the electrical conduit pipe is no longer resting on the sprinkler head deflector and is in accordance with NFPA 101. 2. The upright sprinkler in the outside oxygen storage area was adjusted, so that the deflector was not resting on the ceiling and is in accordance with NFPA 101. 3. The maintenance director/designee conducted a facility wide observation of the sprinkler system to ensure they are maintained in accordance with NFPA 101. No concerns were identified. 4. The maintenance director/designee will conduct weekly (x4 weeks) inspections on the facility automatic fire sprinkler system to ensure they are maintained in accordance with NFPA 101. The results of this audit will be reviewed at the monthly QA meeting until compliance has been determined. AHCA Form 3020-0001 STATE FORM eeee ZXVE21 if continuation sheet 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINTED: 03/11/2025 CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING 01 - MAIN FED (X3) DATE SURVEY COMPLETED 105083 B. WING 02/12/2025 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 (X5) PREFIX TAG (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K 000 INITIAL COMMENTS

K 000 An unannounced Fire & Life Safety recertification survey was conducted on 02/11/25-2/12/25 at Broward Nursing & Rehabilitation Center, a nursing home in Ft. Lauderdale, Florida. Broward Nursing & Rehabilitation Center is not in compliance with 42 CFR 483.90 (a) and National Fire Protection Association (NFPA) 101 (2012 edition), NFPA 99 (2012) requirements for nursing homes. Initial Plan Review: 10/10/2018 Existing NFPA 220 Construction Type: II (111) Number of beds: 198 Census: 154

K 324 The following is description of the noncompliance.

K 324 3/13/25 SS-D Cooking Facilities CFR(s): NFPA 101 Cooking Facilities Cooking equipment is protected in accordance with NFPA 96, Standard for Ventilation 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. Cooking facilities protected according to NFPA 96 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 03/07/2025 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:ZXVE21 Facility ID: 100603 If continuation sheet Page 1 of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PRINTED: 03/11/2025 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 02/12/2025 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 324 Continued From page 1

K 324 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, TIA 12-2 This REQUIREMENT is not met as evidenced by: Based on observations and staff interviews, the facility failed to maintain the commercial kitchen in accordance with NFPA 101. The findings included: On 2/11/2025 at 1:30 p.m. while touring the dietary kitchen with the Director of Maintenance, it was observed that the gas stove mounted on casters failed to have a restraining device installed to limit the movement of the appliance. An interview was conducted with the Director of Maintenance concurrent with the observations and he acknowledged the findings. These findings were reviewed with the Director of Maintenance and the Administrator during the exit conference on 02/12/25 at 1:30 PM. NFPA 101 (2012 edition) 19.3.2.5.1, 9.2.3 NFPA 96 (2011 edition) 12.1.2.2 NFPA 54 (2012 edition) 5.6.1.2 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.

K324 1. A restraining device was installed on the gas stove to limit the movement of the appliance. 2. The maintenance director/designee will conduct monthly inspection to ensure the restraining device is intact and mounted to the wall as part of the facility preventative maintenance program. 3. The maintenance director/designee will conduct weekly (x4 weeks) inspections on the restraining device to ensure it is intact. The results of this audit will be reviewed at the monthly QA meeting until compliance has been determined.

K 353 Sprinkler System - Maintenance and Testing SS-D

K 353 3/13/25 FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: ZXVE21 Facility ID: 100603 If continuation sheet Page 2 of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PRINTED: 03/11/2025 FORM APPROVED OMB NO. 0938-0391 SUMMARY 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 02/12/2025 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 CFR(s): NFPA 101

K 353 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 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 REQUIREMENT is not met as evidenced by: Based on observations and staff interviews, the facility failed to maintain their automatic fire sprinkler system (AFSS) in accordance with NFPA 101. The findings included: The following observations were made while conducting facility tour with the Director of Maintenance. 1. On 02/11/25 at 11:30 AM, on the second floor South Handler Electrical Room there was 1 of 1 sprinkler that had an electrical conduit pipe resting on the sprinkler head deflector. 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.

K353 1. The sprinkler in the second floor South Handler Electrical Room was adjusted, so that the electrical conduit pipe is no longer resting on the sprinkler head deflector and is in accordance with NFPA 101. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: ZXVE21 Facility ID: 100603 If continuation sheet Page 3 of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PRINTED: 03/11/2025 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 02/12/2025 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 353 Continued From page 3 2. On 02/12/25 at 11:45 AM, the outside oxygen storage area had 1 of 1 upright sprinkler that had the deflector resting up to the ceiling. An interview was conducted with the Director of Maintenance concurrent with the observations and he acknowledged the findings. These findings were reviewed with the Director of Maintenance and the Administrator during the exit conference on 02/12/25 at 1:30 PM. Photographic evidence obtained. NFPA 101 (2012 edition) 19.3.5.8, 9.7, 9.7.1.1 (1) NFPA 13 (2010 edition) 8.6.4.1.1.1

K 353 2. The upright sprinkler in the outside oxygen storage area was adjusted, so that the deflector was not resting on the ceiling and is in accordance with NFPA 101. 3. The maintenance director/designee conducted a facility wide observation of the sprinkler system to ensure they are maintained in accordance with NFPA 101. No concerns were identified. 4. The maintenance director/designee will conduct weekly (x4 weeks) inspections on the facility automatic fire sprinkler system to ensure they are maintained in accordance with NFPA 101. The results of this audit will be reviewed at the monthly QA meeting until compliance has been determined. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: ZXVE21 Facility ID: 100603 If continuation sheet Page 4 of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINTED: 03/11/2025 CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING (X3) DATE SURVEY COMPLETED 105083 B. WING 02/12/2025 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 (X5) PREFIX TAG (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE COMPLETION REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY)

E 000 Initial Comments

E 000 During the recertification survey conducted on 02/11/25- 02/12/25 at Broward Nursing & Rehabilitation Center, a nursing home, the Emergency Preparedness Program (EP) was reviewed. Broward Nursing & Rehabilitation Center is in compliance with Emergency Preparedness per CFR (Code of Federal Regulations) 42, Part 483.73, requirement for Long Term Care Facilities. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 03/07/2025 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: ZXVE21 Facility ID: 100603 If continuation sheet Page 1 of 1