Health inspection·September 8, 2023

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, staff interviews, and review of facility records, the facility failed to maintain kitchen food distribution carts in a clean, safe, and sanitary manner for 3 of 5 food carts observed during lunch service to resident rooms. Failure to provide food services that meet standards of professional food service safety place residents at risk for possible illness. The findings include: On 9/8/23 at 12:10 pm, a tour of the facility was conducted during the lunch hour. Dietary staff were observed delivering beverages and meal trays to resident rooms on rolling food carts. On the 200 hallway, a two-tiered plastic rolling cart used to deliver lunch trays to that hall was observed to be stained and soiled. There were drips and splatters resembling food and beverage, and dark smudges, across the side of the cart's vertical surfaces. The four plastic legs were pitted, stained, soiled and scratched. The hydration cart on the 200 hallway was observed to have trash from opened straws and exposed/uncovered cup lids on the shelves, which were stained and soiled. The bottom shelf had an unknown black substance. The top shelf of the cart was also stained and soiled around the edges. The metal cart legs were covered with a substance resembling rust. (Photographic evidence was obtained) During observations on the 600 hallway, meals were delivered on a tall (approximately 5 feet) metal cart. Drips and splatters of what resembled dried-on food and/or beverages were observed on the sides of the carts. (Photographic evidence was obtained) During an interview with the Registered Dietician (RD) at 2:25 pm on 9/8/23, she was asked to provide a kitchen Cleaning Assignment Schedule. The document read September 2023 across the top of the form. One of the tasks listed on the form was Meal Carts and another was Coffee Carts. Most of the tasks were signed off by staff but there no tasks dated past 8/30/23. The meal and coffee carts were signed off as completed but there was no date indicating the last time they were cleaned. (Photographic evidence was obtained) The RD stated she was not aware of how often the carts were to be cleaned but had seen staff wipe them down between meals. When shown the photographic evidence, she said, That's not good. They should at least wipe them before distributing the meals. On 9/8/23 at 2:35 pm, Dietary Aid (DA) A was interviewed. When asked about the lunch carts, she stated they used to have a porter who would take the coffee and food carts outside and power wash them daily. Since there was currently no porter, staff just wipe them down after meals with soapy water and a rag. The DA was shown the pictures. Upon seeing the condition of the carts, she said, Oh God, that's not good! She confirmed the carts were not clean and they needed daily and deep cleaning. (continued on next page) 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. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 105038 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachside Center for Rehabilitation and Nursing 2810 South Atlantic Avenue New Smyrna Beach, FL 32169 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)