Health inspection·June 29, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on interview and record review, the facility failed to honor the resident's choice of food for one (Resident #109) out of three residents investigated for food. This deficient practice has the potential to limit the residents' right to make personal dietary choices. The facility had a census of 136 residents at the time of this survey. Findings included: During an interview on 06/26/23 at 10:36 AM, Resident #109 stated, I don't like the food. I used to get boiled eggs, but now they changed it to scrambled eggs. I don't like scrambled eggs; I preferred boiled egg. I never eat scrambled or fried eggs. They can see that I never eat their eggs. During an interview on 06/28/23 at 09:18 AM with Staff B, a CNA (Certified Nursing Assistant), regarding resident's food choices, Staff B stated, as CNAs, they don't really know about the residents' diet. They only go and set up the food for the residents; however, the residents always have options when they give them the food. They can call the kitchen or let them know if they don't like the food, so they can bring something else. Staff B further stated, she knew Resident #109 sometimes requests for other food. She stated, she had seen they sent her boiled eggs and sometimes scrambled eggs, muffin, flat bread, jelly and other choices of food before. Also, they always give Resident #109 a lot of food, so she can choose what she wants. On 06/28/23 at 02:06 PM, during a follow up interview with Resident #109, the resident stated, They gave me scrambled eggs this morning. I didn't eat it. I didn't tell them this morning, but I told them before. They still bring it to me. During an interview with Staff C, Licensed Practical Nurse (LPN), on 06/28/23 at 02:12 PM regarding Resident #109's food choices, Staff C stated, the only food she knew that Resident #109 doesn't like is cereal with dry raisins. Staff C stated, she didn't know about Resident #109's egg preferences. Staff C further stated, if a resident doesn't like a food, the resident would tell a CNA or a nurse, then the CNA or the nurse would call the Dietitian to come and talk to the resident to change the resident's food preference. On 06/28/23 at 02:19 PM, the Dietary Director stated, For food preferences, we make notes in the system. I don't know the food preference for breakfast for Resident #109. My Dietitian spoke to her. On 06/28/23 at 02:27 PM while interviewing the Dietitian inside Resident #109's room regarding food preferences, Resident #109 stated, I spoke to her (Dietitian) about the eggs. That time, I told her that I wanted salt. Since then, I've been getting fried or scrambled eggs. They used to give me (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 3 Event ID: 105172 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 105172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161 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)