Inspection·March 20, 2025

Agency for Health Care Administration PRINTED: 04/08/2025 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 R 03/20/2025 100603 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 000} INITIAL COMMENTS {K 000} An unannounced Fire & Life Safety revisit survey was conducted on 03/20/25 at Broward Nursing and Rehabilitation Center, a Nursing Home in Ft. Lauderdale, Florida. This was a follow-up to the annual Fire & Life Safety survey completed on 02/12/25. All previously cited Fire & Life Safety deficiencies were corrected. AHCA Form 3020-0001 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed STATE FORM 8899 ZXVE22 If continuation sheet 1 of 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINTED: 04/08/2025 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 01 - MAIN FED (X3) DATE SURVEY COMPLETED 105083 B. WING R 03/20/2025 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 revisit survey was conducted on 03/20/25 at Broward Nursing and Rehabilitation Center, a Nursing Home in Ft. Lauderdale, Florida. This was a follow-up to the annual Fire & Life Safety survey completed on 02/12/25. All previously cited Fire & Life Safety deficiencies were corrected. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 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: ZXVE22 Facility ID: 100603 If continuation sheet Page 1 of 1