Inspection·April 3, 2025

Agency for Health Care Administration STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 100603 (X2) MULTIPLE CONSTRUCTION A. BUILDING: ______ B. WING ______ (X3) DATE SURVEY COMPLETED R 04/03/2025 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) COMPLETE DATE (N 000) INITIAL COMMENTS (N 000) An unannounced revisit to the Relicensure survey was conducted on 04/03/25 at Broward Nursing & Rehabilitation Center. Previously cited Health deficiencies were found to be corrected at the time of the survey. AHCA Form 3020-0001 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 04/09/25 STATE FORM 8899 ZXVE12 If continuation sheet 1 of 1 PRINTED: 04/10/2025 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PRINTED: 04/10/2025 FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A. BUILDING (X3) DATE SURVEY COMPLETED R 105083 B. WING 04/03/2025 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 (F 000) INITIAL COMMENTS (F 000) An unannounced revisit to the Recertification survey was conducted on 04/03/25 at Broward Nursing & Rehabilitation Center. The facility was in compliance with CFR 42, Part 483, Requirement for Long Term Care Facilities. Previously cited deficiencies were corrected. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Electronically Signed 04/09/2025 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 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: ZXVE12 Facility ID: 100603 If continuation sheet Page 1 of 1