Inspection·October 3, 2025

K0222 SS = F Egress Doors CFR(s); NFPA 101 Egress Doors Doors in a required means of egress shall not be equipped with a latch or a lock that requires the use of a tool or key from the egress side unless using one of the following special arrangements: CLINICAL NEEDS OR SECURITY THREAT LOCKING Where special locking arrangements for the clinical security needs of the patient are used, only one locking device shall be permitted on each door and provisions shall be made for the rapid removal of occupants by remote control of locks; keying of all locks or keys carried by staff at all times; or other such reliable means available to the staff at all times. 18.2.2.2.5.1, 18.2.2.2.6, 19.2.2.2.5.1, 19.2.2.2.6 SPECIAL NEEDS LOCKING ARRANGEMENTS Where special locking arrangements for the safety needs of the patient are used, all of the Clinical or Security Locking requirements are being met. In addition, the locks must be electrical locks (that fail safely so as to release upon loss of power to the device); the building is protected by a supervised automatic sprinkler system and the locked space is protected by a complete smoke detection system (or is constantly monitored at an attended location within the locked space); and both the sprinkler and detection systems are arranged to unlock the doors upon activation. 18.2.2.2.5.2, 19.2.2.2.5.2. DELAYED-EGRESS LOCKING ARRANGEMENTS Approved, listed delayed-egress locking systems installed in accordance with 7.2.1.6.1 shall be permitted on door assemblies serving low and ordinary hazard contents in buildings protected throughout by an

K0222 What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: Egress doors identified as non-compliant were immediately evaluated. Necessary repairs and adjustments were completed to ensure the doors open freely, are unobstructed, and meet Life Safety Code (LSC) requirements. Any defective hardware was repaired or replaced, and all doors now operate properly without impediments. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: A facility-wide audit of egress doors was conducted to identify any additional doors that might be out of compliance. Any issues found during the audit were corrected immediately to ensure all egress pathways remain accessible, free from obstruction, and fully functional during an emergency. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: Maintenance Director was educated by administrator, for checks for obstructions, damaged hardware, failed closers, and improper locking devices on egress doors. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: The Maintenance Director/designee will perform audits that will be conducted weekly for four weeks, then monthly for three months. Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations. Any deficiency statement ending in an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that 105572 POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0222 SS = F Continued from page 1 approved, supervised automatic fire detection system or an approved, supervised automatic sprinkler system. 18.2.2.4, 19.2.2.4

K0222 ACCESS-CONTROLLED EGRESS LOCKING ARRANGEMENTS Access-Controlled Egress Door assemblies installed in accordance with 7.2.1.6.2 shall be permitted. 18.2.2.4, 19.2.2.4 ELEVATOR LOBBY EXIT ACCESS LOCKING ARRANGEMENTS Elevator lobby exit access door locking in accordance with 7.2.1.6.3 shall be permitted on door assemblies in buildings protected throughout by an approved, supervised automatic fire detection system and an approved, supervised automatic sprinkler system. 18.2.2.4, 19.2.2.4 This STANDARD IS NOT MET as evidenced by: Based on observation and staff interview, the facility failed to maintain egress doors equipped with delayed egress locking arrangements in accordance with NFPA 101, for 10 of 10 delayed egress doors. This affects all staff and residents in the facility by delaying egress needlessly in an emergency. The findings included: On , at the following times, during the fire safety tour of the facility with the Maintenance Director, the following was observed: 1. Between 2:30 PM and 4:30 PM, the facility has a 30-second delayed egress locking arrangement on 9 of 10 doors equipped with delayed egress. Documentation was requested providing approval from the local Authority Having Jurisdiction (AHJ) for the 30-second delayed egress locking arrangements. Documentation was not provided before the end of the survey stating that the facility was approved to have 30-second delayed egress locking arrangements. 2. At 3:35 PM, the double emergency exit doors, near , equipped with thirty-second delayed egress locking arrangement, right leaf would not open individually from the left leaf. The right leaf had 105572 POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0222 SS = F Continued from page 2 panic hardware installed and no automatic flush bolts.

K0222 3. At 3:49 PM, the double emergency exit doors, near , equipped with thirty-second delayed egress locking arrangement, right leaf would not open individually from the left leaf. The right leaf had panic hardware installed and no automatic flush bolts. 4. At 4:06 PM, the double emergency exit doors, near the Activity Community Center, equipped with thirty-second delayed egress locking arrangement, right leaf would not open individually from the left leaf. The right leaf had panic hardware installed and no automatic flush bolts. The right leaf was missing the required signage. 5. At 4:09 PM, the Activity Community Center exit door equipped with a thirty-second delayed egress locking arrangement was obstructed by sandbags on the exterior side. 6. At 4:15 PM, the cross-corridor smoke doors, located near Central Supply, equipped with a fifteen-second delayed egress locking arrangement, failed to operate when tested. 7. At 4:51 PM, the North Wing double emergency exit doors, equipped with thirty-second delayed egress locking arrangement, right leaf would not open individually from the left leaf. The right leaf had panic hardware installed and no automatic flush bolts. 8. At 5:00 PM, the Rehabilitation Room emergency exit, equipped with a thirty-second delayed egress locking arrangement, had a chair obstructing egress. An interview was conducted with Maintenance Director concurrent with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM. NFPA 101 (2012 Edition) 7.1.9, 7.2.1.5.9, 7.2.1.6.1.1(3), 7.2.1.6.1.1(4)(a), 19.2.1, 19.2.2.4(2) POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 --- | --- | --- | --- | ---

K0222 | Continued from page 3. | K0222 | | SS = F | | | |

K0324 | Photographic evidence obtained. | K0324 | | SS = F | | | | | Cooking Facilities | | | | CFR(s): NFPA 101 | | | | Cooking Facilities | | | | Cooking equipment is protected in accordance with NFPA 96, Standard for 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 per 9.2.3 are not required to be enclosed to 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. | This STANDARD is NOT MET as evidenced by: | Based on observation and staff interview, the facility failed to maintain their commercial cooking facility in accordance with NFPA 101, for 1 of 1 commercial cooking hood suppression system. This deficiency affects all residents and staff in the smoke compartment by allowing grease to build up internally creating a fire hazard. | The findings included: | On , at 4:20 PM, during the fire safety tour of the facility with the Maintenance Director, the commercial cooking hood suppression system seams were not sealed or otherwise made grease/tight. | An interview was conducted with Maintenance Director concurrent with the observations and he acknowledged | | | | | K0324 | What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: | | | The facility contacted our licensed fire protection contractor to inspect, test, and service the kitchen hood fire suppression system. Any identified deficiencies have been corrected. The cooking hood system is now fully operational, inspected, and compliant with NFPA 101 requirements. | | | How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: | | | Facility kitchen suppression components inspected, including the automatic extinguishing system, manual pull station, hood filters, and fuel shutoff interlocks, was completed to ensure no other areas were affected. No additional deficiencies were found. | | | What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: | | | Maintenance Director was educated by administrator for Kitchen hood fire suppression system to be checked and inspected for compliance with NFPA 101 requirements. | | | How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: | | | The Maintenance Director/designee will perform audits that will be conducted weekly for four weeks, then monthly for three months on the kitchen hood. | | | Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations. | /2025 105572 POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0324 SS = F Continued from page 4 the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM. NFPA 96 (2011 Edition) 5.1.4 NFPA 101 (2012 Edition) 2.1, 4.5.8, 4.6.12.1, 9.2.3, 19.3.2.5.1 Photographic evidence obtained.

K0345 SS = F Fire Alarm System - Testing and Maintenance CFR(s): NFPA 101 Fire Alarm System - Testing and Maintenance A fire alarm system is tested and maintained in accordance with an approved program complying with the requirements of NFPA 70, National Electric Code, and NFPA 72, National Fire Alarm and Signaling Code. Records of system acceptance, maintenance and testing are readily available. 9.6.1.3, 9.6.1.5, NFPA 70, NFPA 72 This STANDARD is NOT MET as evidenced by: Based on record review, and staff interview, the facility failed to maintain their fire alarm system in accordance with NFPA 101, for 1 of 1 fire alarm system. This deficiency affects all residents and staff in the facility by potentially delaying the system activation during a fire or smoke emergency. The findings included: On , at 11:10 AM, during record review with the Maintenance Director, it was revealed that the documentation provided for the biennial smoke detector sensitivity testing, dated , stated that 12 of 74 smoke detectors were not tested. No documentation was provided stating that the twelve smoke detectors were tested. An interview was conducted with Maintenance Director concurrent with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM.

K0345 What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: An inspection of smoke detectors in the facility performed to verify their operational status and testing, and any faulty or non-compliant devices were promptly removed from service. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: Facility internal inspection was performed by Maintenance Director. No additional deficiencies were found. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: Facility-wide inspection and internal audits of fire alarm system testing, including smoke detector checks to ensure that smoke detectors are tested annually and upon any installation or system modification, in accordance with NFPA 72. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: Maintenance Director was educated by administrator for fire alarm system testing, including smoke detector checks and audits that will be conducted weekly for four weeks, then monthly for three months. Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations. /2025 POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0345 SS = F Continued from page 5

K0345

K0345 SS = F NFPA 101 (2012 Edition) 4.6.12, 9.6, 19.3.4.1 NFPA 72 (2010 Edition) 7.7.1.1, 14.4.3.2, 14.6.2.1 Photographic evidence obtained.

K0921 SS = F Electrical Equipment - Testing and Maintenanc

K0921 What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: /2025 CFR(s): NFPA 101 Electrical Equipment - Testing and Maintenance Requirements The physical integrity, resistance, leakage current, and touch current tests for fixed and portable patient-care related electrical equipment (PCREE) is performed as required in 10.3. Testing intervals are established with policies and protocols. All PCREE used in patient care rooms is tested in accordance with 10.3.5.4 or 10.3.6 before being put to service and after any repair or modification. Any system consisting of several electrical appliances demonstrates compliance with NFPA 99 as a complete system. Service manuals, instructions, and procedures provided by the manufacturer include information as required by 10.5.3.1.1 and are considered in the development of a program for electrical equipment maintenance. Electrical equipment instructions and maintenance manuals are readily available, and safety labels and condensed operating instructions on the appliance are legible. A record of electrical equipment tests, repairs, and modifications is maintained for a period of time to demonstrate compliance in accordance with the facility's policy. Personnel responsible for the testing, maintenance and use of electrical appliances receive continuous training. 10.3, 10.5.2.1, 10.5.2.1.2, 10.5.2.5, 10.5.3, 10.5.6, 10.5.8 This STANDARD is NOT MET as evidenced by: Based on record review and staff interview, the facility failed to test and maintain their electrical equipment in accordance with NFPA 99, for 12 of 12 smoke compartments. This deficiency affects all residents in the facility and the potential electric electrical equipment. The findings included: What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: Smoke compartments that were not tested during the required interval were inspected and tested and any deficiencies identified during the testing were corrected or repaired. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: Facility internal inspection was performed by Maintenance Director. No additional deficiencies were found. What measures will be put in place or what systematic changes you will make to ensure that the deficient practice does not recur: Maintenance Director was educated by administrator for audits of smoke compartments, smoke barrier doors, and fire alarm zone testing documentation was completed. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: The Maintenance Director/designee will perform internal audits that will be conducted weekly for four weeks, then monthly for three months. Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations 105572 POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

K0921 SS = F Continued from page 6 On , at 1:20 PM, during record review with the Maintenance Director, it was revealed that no documentation could be provided for the bio-medical equipment testing in the last year. On , at 3:58 PM, during the fire safety tour of the facility with the Maintenance Director, it was observed in the corridor, near , an electronic vitals machine was charging. The bio-medical equipment inspection sticker stated that inspection was due before . No documentation was provided stating the equipment was inspected within the last year. An interview was conducted with Maintenance Director concurrent with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM. NFPA 99 (2012 Edition) 10.3, 10.5.2.1, 10.5.2.1.1, 10.5.2.1.2, 10.5.2.7, 10.5.3 Photographic evidence obtained.

K0917 SS = E Electrical Systems - Essential Electric Syste CFR(s): NFPA 101 Electrical Systems - Essential Electric System Receptacles Electrical receptacles or cover plates supplied from the life safety and critical branches have a distinctive color or marking. 6.4.2.2.6, 6.5.2.2.4.2, 6.6.2.2.3.2 (NFPA 99) This STANDARD is NOT MET as evidenced by: Based on observation and staff interview, the facility failed to ensure the critical branch supplied power to select receptacles serving medication preparation areas in accordance with NFPA 99, for 2 of 3 medication refrigerators. This deficiency affects residents that reside in the area of the two nurses' stations that house the medicine refrigerators.

K0917 What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: /2025 An inspection of medication refrigerator receptacles was performed and those found to be non-functioning or failed were removed from service and replaced. How will you identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: Facility internal inspection was performed by Maintenance Director. No additional deficiencies were found. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: Maintenance Director was educated by administrator for patientcare and critical-equipment receptacles (including medication rooms, medication refrigerators, POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064

K0917 SS = E Continued from page 7 The findings included:

K0917 Continued from page 7 crash carts, laboratory refrigerators, and medication prep areas) was completed by the Maintenance Director. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: The Maintenance Director/designee will perform monthly internal audits of receptacles that will be conducted weekly for four weeks, then monthly for three months. Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations. On , between 4:40 PM and 4:50 PM, during the fire safety tour of the facility with the Maintenance Director, it was observed that the West and the North Wings medicine room receptacle refrigerators were not in a distinctly marked receptacle, supplied with power from the critical branch. An interview was conducted with Maintenance Director concurrent with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM. NFPA 99 (2012 Edition) 6.1.3, 6.4.1, 6.7.2.2.5(B), 6.7.5, 6.7.5.1.3, 6.7.5.1.3.2(2)(b)(c). Photographic evidence obtained.

K0000 INITIAL COMMENTS

K0000 /2025 Bldg. 01 An unannounced Fire & Life Safety Recertification survey was conducted on at Pompano Health and Rehabilitation Center, a nursing home in Pompano Beach, Florida. Pompano Health and Rehabilitation Center is not in compliance with 42 CFR 483 Subpart B, 42 CFR 488.307, and National Fire Protection Association (NFPA) 101 (2012 Edition), NFPA 99 (2012 Edition) requirements for nursing homes. Initial Plan Review: 1983 Existing NFPA 220 Construction Type: II (111) Number of beds: 127 Census: 119 The following is a description of the noncompliance. POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

E0024 SS = F Policies/Procedures-Volunteers and Staffing CFR(s): 483.73(b)(6) §403.748(b)(6), §416.54(b)(5), §418.113(b)(4), §441.184(b)(6), §460.84(b)(7), §482.15(b)(6), §483.73(b)(6), §483.475(b)(6), §484.102(b)(5), §485.69(b)(4), §485.542(b)(6), §485.625(b)(6), §485.727(b)(4), §485.920(b)(5), §491.12(b)(4), §494.62(b)(5). (b) Policies and procedures. The (facilities) must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, and the communication plan set forth in paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years [annually for LTC facilities], at a minimum, the policies and procedures must address the following:] (6) [or (4), (5), or (7) as noted above] The use of volunteers in an emergency or other emergency staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency. [*For RNHCIs at §403.748(b)] Policies and procedures. (6) The use of volunteers in an emergency and other emergency staffing strategies to address surge needs during an emergency. [*For Hospice at §418.113(b)] Policies and procedures. (4) The use of hospice employees in an emergency and other emergency staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency. This STANDARD IS NOT MET as evidenced by: Preparation, submission and or execution of this Plan of Correction does not constitute admission or agreement by the provider of the truth of the items alleged or conclusion set forth in the statement of deficiencies. The plan of correction is prepared and executed as required by State and Federal law. What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice? The Emergency Preparedness (EP) Committee reviewed and updated the facility’s Emergency Preparedness Plan (EOP) to include detailed procedures for surge capacity management. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken? Surge planning will be conducted by the Maintenance Director to the EP Committee. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur? Maintenance Director was educated by administrator to maintain documentation of surge drills and updates. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place? The Maintenance Director/designee will perform surge drill audits that will be conducted weekly for four weeks, then monthly for three months. Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations. POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

E0024 SS = F Continued from page 1 Based on record review and staff interview, the facility failed to demonstrate how they would incorporate the use of volunteers in an emergency or other emergency staffing strategies, including the process and role for the integration of State and Federally designated health care professionals to address surge needs during an emergency in their Emergency Preparedness Program (EP), in accordance with Code of Federal Regulations (CFR). The findings included: On facility's EP , at 5:20 PM, during record review of the facility with the Administrator, there was no policy and procedures which include the process and role for integration of State or Federally designated health care professionals to address surge needs during an emergency. An interview was conducted with the Administrator concurrently with the record review and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM. 42 CFR 483.73(b)(6)

E0024

E0031 SS = F Emergency Officials Contact Information CFR§: 483.73(c)(2) §403.748(c)(2), §416.54(c)(2), §418.113(c)(2), §441.184(c)(2), §460.84(c)(2), §482.15(c)(2), §483.73(c)(2), §483.475(c)(2), §484.102(c)(2), §485.68(c)(2), §485.542(c)(2), §485.625(c)(2), §485.727(c)(2), §485.920(c)(2), §486.360(c)(2), §491.12(c)(2), §494.62(c)(2). (c) The [facility] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following: (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff.

E0031 What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: The Emergency Preparedness (EP) Committee reviewed and updated the facility's Emergency Contact information. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: Contact information was reviewed and updated by the EP Committee. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: Maintenance Director educated on the communication plan for contact information. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: /2025 105572 POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

E0031 SS = F Continued from page 2 (ii) Other sources of assistance. *For LTC Facilities at §483.73(c)(1) (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) The State Licensing and Certification Agency. (iii) The Office of the State Long-Term Care Ombudsman. ( ) Other sources of assistance. *For ICF/IIDs at §483.475(c)(1) (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. (iii) The State Licensing and Certification Agency. ( ) The State Protection and Advocacy Agency. This STANDARD is NOT MET as evidenced by: Based on record review and staff interview, the facility failed to incorporate all the required elements in their communication plan for their Emergency Preparedness Program (EP), in accordance with the Code of Federal Regulations (CFR). The findings included: On , at 5:32 PM, during record review of the facility's EP with the Administrator, there was no State Licensing and Certification Agency contact information documented in the plan. An interview was conducted with the Administrator concurrently with the record review and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM.

E0031 Continued from page 2 The Maintenance Director/designee will perform audits that will be conducted weekly for four weeks, then monthly for three months. Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations 42 CFR 483.73(c)(2)(ii) 105572 POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETION DATE

E0031

E8009 Initial Comments

E0031

E0000 During the Fire & Life Safety Recertification survey, conducted on at Pompano Health and Rehabilitation Center, a nursing home, Emergency Preparedness was reviewed. Pompano Health and Rehabilitation Center is not in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 483.73, Requirement for Long-Term Care Facilities. /2025 Florida Department of Health POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064

K0222 SS = F Egress Doors Doors within a required means of egress shall not be equipped with a latch or lock that requires the use of a tool or key from the egress side, unless otherwise permitted by one of the following: (1) Locks complying with 18/19.2.2.5 shall be permitted. (2) Delayed-egress electrical locking systems complying with 7.2.1.6.1 shall be permitted. (3) Sensor-release of electrical locking systems complying with 7.2.1.6.2 shall be permitted. (4) Elevator lobby exit access door locking in accordance with 7.2.1.6.4 shall be permitted. (5) Approved existing door-locking installations shall be permitted. 18.2.2.4 through 18.2.2.7, 19.2.2.4 through 19.2.2.7 This LICENSURE REQUIREMENT is NOT MET as evidenced by: Based on observation and staff interview, the facility failed to maintain egress doors equipped with delayed egress locking arrangements in accordance with NFPA 101, for 10 of 10 delayed egress doors. This affects all staff and residents in the facility by delaying egress needlessly in an emergency. The findings included: On , at the following times, during the fire safety tour of the facility with the Maintenance Director, the following was observed: 1. Between 2:30 PM and 4:30 PM, the facility has a 30-second delayed egress locking arrangement on 9 of 10 doors equipped with delayed egress. Documentation was requested providing approval from the local Authority Having Jurisdiction (AHJ) for the 30-second delayed

K0222 What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: Egress doors identified as non-compliant were immediately evaluated. Necessary repairs and adjustments were completed to ensure the doors open freely, are unobstructed, and meet Life Safety Code (LSC) requirements. Any defective hardware was repaired or replaced, and all doors now operate properly without impediments. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: A facility-wide audit of egress doors was conducted to identify any additional doors that might be out of compliance. Any issues found during the audit were corrected immediately to ensure all egress pathways remain accessible, free from obstruction, and fully functional during an emergency. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: Maintenance Director was educated by administrator, for checks for obstructions, damaged hardware, failed closers, and improper locking devices on egress doors. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: The Maintenance Director/designee will perform audits that will be conducted weekly for four weeks, then monthly for three months. Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations. Office of Primary Care and Health Systems Management Florida Department of Health PRINTED: 12/04/2025

K0222 SS = F Continued from page 1 egress locking arrangements. Documentation was not provided before the end of the survey stating that the facility was approved to have 30-second delayed egress locking arrangements. K0222 2. At 3:35 PM, the double emergency exit doors, near , equipped with thirty-second delayed egress locking arrangement, right leaf would not open individually from the left leaf. The right leaf had panic hardware installed and no automatic flush bolts. 3. At 3:49 PM, the double emergency exit doors, near , equipped with thirty-second delayed egress locking arrangement, right leaf would not open individually from the left leaf. The right leaf had panic hardware installed and no automatic flush bolts. 4. At 4:06 PM, the double emergency exit doors, near the Activity Community Center, equipped with thirty-second delayed egress locking arrangement, right leaf would not open individually from the left leaf. The right leaf had panic hardware installed and no automatic flush bolts. The right leaf was missing the required signage. 5. At 4:09 PM, the Activity Community Center exit door equipped with a thirty-second delayed egress locking arrangement was obstructed by sandbags on the exterior side. 6. At 4:15 PM, the cross-corridor smoke doors, located near Central Supply, equipped with a fifteen-second delayed egress locking arrangement, failed to operate when tested. 7. At 4:51 PM, the North Wing double emergency exit doors, equipped with thirty-second delayed egress locking arrangement, right leaf would not open individually from the left leaf. The right leaf had panic hardware installed and no automatic flush bolts. 8. At 5:00 PM, the Rehabilitation Room emergency exit, equipped with a thirty-second delayed egress locking arrangement, had a chair obstructing egress. An interview was conducted with Maintenance Director

K0222 SS = F Continued from page 2 concurrent with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM. K0222 NFPA 101 (2021 Edition) 7.1.9, 7.2.1.5.9, 7.2.1.6.1.1(3), 7.2.1.6.1.1(4)(a), 19.2.1, 19.2.2.2.4(2). Photographic evidence obtained. Class III

K0324 SS = F Cooking Facilities Cooking Facilities What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: /2025 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 19.3.2.5.3, 9.2.3 This LICENSURE REQUIREMENT IS NOT MET as evidenced by: Based on observation and staff interview, the facility failed to maintain their commercial cooking facility in accordance with NFPA 101, for 1 of 1 commercial cooking hood suppression system. This deficiency affects all residents and staff in the smoke compartment by allowing grease to build up internally creating a fire hazard. The findings included: On , at 4:20 PM, during the fire safety tour of the facility, with the Maintenance Director, the commercial cooking hood suppression system seams were not sealed or otherwise made gastight. An interview was conducted with Maintenance Director concurrent with the observations and he acknowledged the findings. The findings were reviewed with the The facility contacted our licensed fire protection contractor to inspect, test, and service the kitchen hood fire suppression system. Any identified deficiencies were corrected. The cooking hood system is now fully operational, inspected, and compliant with NFPA 101 requirements. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: Facility kitchen suppression components inspected, including the automatic extinguishing system, manual pull station, hood filters, and fuel shutoff interlocks, was completed, to ensure no other areas were affected. No additional deficiencies were found. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: Maintenance Director was educated by administrator for Kitchen hood fire suppression system to be checked and inspected for compliance with NFPA 101 requirements. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: The Maintenance Director/designee will perform audits that will be conducted weekly for four weeks, then monthly for three months on the kitchen hood. Maintenance Director/designee to report findings --- | --- | --- | --- | ---

K0324 SS = F | Continued from page 3 Administrator and the Maintenance Director at the exit conference on at 5:45 PM. <br> NFPA 96 (2021 Edition) 5.1.4, 10.2.6 <br> NFPA 101 (2021 Edition) 2.1, 4.5.8, 4.6.12.1, 9.2.3, 19.3.2.5.1 <br> Photographic evidence obtained. | K0324 | Continued from page 3 through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations. |

K0345 SS = F | Fire Alarm System - Testing and Maintenance <br> Fire Alarm System - Testing and Maintenance <br> Detection systems, where required, shall be in accordance with Section 9.6. Fire alarm systems required by this Code shall be installed, tested, and maintained in accordance with the applicable requirements of NFPA70 and NFPA72 unless otherwise permitted by 9.6.1.4. 18.3.4.1, 19.3.4.1, 9.6, and NFPA 70, and NFPA 72 <br> This LICENSURE REQUIREMENT is NOT MET as evidenced by: <br> Based on record review, and staff interview, the facility failed to maintain their fire alarm system in accordance with NFPA 101, for 1 of 1 fire alarm system. This deficiency affects all residents and staff in the facility by potentially delaying the system activation during a fire or smoke emergency. <br> The findings included: <br> On , at 11:10 AM, during record review with the Maintenance Director, it was revealed that the documentation provided for the biennial smoke detector sensitivity testing, dated , stated that 12 of 74 smoke detectors were not tested. No documentation was provided stating that the twelve smoke detectors were tested. <br> An interview was conducted with Maintenance Director concurrent with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM. | K0345 | What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: <br> An inspection of smoke detectors in the facility performed to verify their operational status and testing, and any faulty or non-compliant devices were promptly removed from service. <br> How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: <br> Facility internal inspection was performed by Maintenance Director. No additional deficiencies were found. <br> What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: <br> Facility-wide inspection and internal audits of fire alarm system testing, including smoke detector checks to ensure that smoke detectors are tested annually and upon any installation or system modification, in accordance with NFPA 72. <br> How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: <br> Maintenance Director was educated by administrator for fire alarm system testing, including smoke detector checks and audits that will be conducted weekly for four weeks, then monthly for three months. <br> Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations. | /2025 Florida Department of Health POMPANO HEALTH AND REHABILITATION CENTER 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064

K0345 SS = F Continued from page 4 K0345 NFPA 101 (2021 Edition) 4.6.12, 9.6, 19.3.4.1 NFPA 72 (2019 Edition) 7.7.1.1, 14.4.4.3.2, 14.6.2.1 Photographic evidence obtained. Class III

K0921 SS = F Electrical Equipment - Testing and Maintenance Electrical Equipment - Testing and Maintenance Requirements K0921 What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: Smoke compartments that were not tested during the required interval were inspected and tested and any deficiencies identified during the testing were corrected or repaired. How will you identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: Facility internal inspection was performed by Maintenance Director. No additional deficiencies were found. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: Maintenance Director was educated by administrator for audits of smoke compartments, smoke barrier doors, and fire alarm zone testing documentation was completed. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: The Maintenance Director/designee will perform internal audits that will be conducted weekly for four weeks, then monthly for three months. Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations /2025 The physical integrity, resistance, leakage current, and touch current related tests for fixed and portable patient-care related electrical equipment (PCREE) is performed as required in 10.3. Testing intervals are established with policies and protocols. All PCREE used in patient care rooms is tested in accordance with 10.3.5.4 or 10.3.6 before being put into service and after any repair or modification. Any system consisting of several electrical appliances demonstrates compliance with NFPA 99 as a complete system. Service manuals, instructions, and procedures provided by the manufacturer include information as required by 10.5.3.1.1 and are considered in the development of a program for electrical equipment maintenance. Electrical equipment instructions and maintenance manuals are readily available, and safety labels and condensed operating instructions on the appliance are legible. A record of electrical equipment tests, repairs, and modifications is maintained for a period of time to demonstrate compliance in accordance with the facility's policy. Personnel responsible for the testing, maintenance and use of electrical appliances receive continuous training. 10.3, 10.5.2.1, 10.5.2.1.2, 10.5.2.5, 10.5.3, 10.5.6, 10.5.8 (NFPA 99) This LICENSURE REQUIREMENT IS NOT MET as evidenced by: Based on record review and staff interview, the facility failed to test and maintain their electrical equipment in accordance with NFPA 99, for 12 of 12 smoke compartments. This deficiency affects all residents in the facility by potential electric and the potential .. of the patient care electrical equipment. STATE FORM Florida Department of Health

K0921 SS = F Continued from page 5 The findings included: On , at 1:20 PM, during record review with the Maintenance Director, it was revealed that no documentation could be provided for the bio-medical equipment testing in the last year. On , at 3:58 PM, during the fire safety tour of the facility with the Maintenance Director, it was observed in the corridor, near , an electronic vitals machine was charging. The bio-medical equipment inspection sticker stating that inspection was due before documentation was provided stating the equipment was inspected within the last year. An interview was conducted with Maintenance Director concurrent with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on at 5:45 PM. NFPA 99 (2021 Edition) 10.3, 10.5.2.1, 10.5.2.1.1, 10.5.2.1.2, 10.5.2.6, 10.5.3 Photographic evidence obtained.

K0917 SS = E Electrical Systems - Essential Electric Syste Electrical Systems - Essential Electric System Receptacles Electrical receptacles or cover plates supplied from the life safety and critical branches have a distinctive color or marking. 6.7.6.3.2 (NFPA 99) This LICENSURE REQUIREMENT IS NOT MET as evidenced by: Based on observation and staff interview, the facility failed to ensure the critical branch supplied power to select receptacles serving medication preparation areas in accordance with NFPA 99, for 2 of 3 medication refrigerators. This deficiency affects residents that reside in the area of the two nurses' stations that

K0921 | | K0921 | |

K0917 | | K0917 | What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: An inspection of medication refrigerator receptacles was performed and those found to be non-functioning or failed were removed from service and replaced. How will you identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken: Facility internal inspection was performed by Maintenance Director. No additional deficiencies were found. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur: | /2025 STATE FORM Florida Department of Health 10/03/2025 51 W SAMPLE ROAD, POMPANO BEACH, Florida, 33064 PREFIX PREFIX CROSS-REFERENCED TO THE COMPLETION DATE

K0917 SS = E Continued from page 6 house the medicine refrigerators. The findings included: On fire safety tour of the facility with the Maintenance Director, it was observed that the West and the North Wings medicine room medicine refrigerators were not in a distinctly marked receptacle, supplied with power from the critical branch. An interview was conducted with Maintenance Director concurrent with the observations and he acknowledged the findings. The findings were reviewed with the Administrator and the Maintenance Director at the exit conference on 5:45 PM. NFPA 99 (2021 Edition) 6.1.3, 6.4.1, 6.7.2.5(B), 6.7.5, 6.7.5.1.3, 6.7.5.1.3.2(2)(b)(c) Photographic evidence obtained. K0917 Continued from page 6 Maintenance Director was educated by administrator for patientcare and critical-equipment receptacles (including medication rooms, medication refrigerators, crash carts, laboratory refrigerators, and medication prep areas) was completed by the Maintenance Director. How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put in place: The Maintenance Director/designee will perform monthly internal audits of receptacles that will be conducted weekly for four weeks, then monthly for three months. Maintenance Director/designee to report findings through the monthly Quality Assessment and Assurance Compliance Committee for comments and recommendations.

K0000 INITIAL COMMENTS K0000 /2025 Bldg. 05 An unannounced Fire & Life Safety re-licensure survey was conducted on at Pompano Health and Rehabilitation Center, a nursing home in Pompano Beach, Florida in accordance with National Fire protection Association (NFPA) 1 and 101 (2021 Edition) and applicable requirements of Florida State Fire Marshal's Rules and Regulations, Florida Administrative Code (F.A.C.) 69A-3, F.A.C. 69A-53, F.A.C. 59A-4, and Florida Statutes (F.S.) 400 Part II, and F.S. 633.0215, adopting National Fire Protection Association (NFPA) 1 and 101 (2021 Edition) known as the Florida Fire Prevention Code and all NFPA program referenced standards and requirements adopted per NFPA 101, Chapter 2. The following is a description of the deficiencies found at the time of the visit.