Inspection·July 31, 2025

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 observations, interviews and records reviewed, the facility failed to ensure one (Resident #72) out of the eleven residents that eat independently had a dignified dining experience. As evidence by during the lunch meal in the dining room Resident # 72 did not receive a meal tray while the table mate had received her meal and had started eating. The findings included: During dining observation on 07/28/2025 there were 11 residents in the dining room, seated with two residents per table. At approximately 11:55 AM when the meal cart arrived staff members distributed the meal trays. Resident #72 was seated with another resident when the meal cart arrived. The resident seated with Resident #72 was served and had started eating but Resident #72 was not served.On 07/28/2025 at 12:22 PM, Staff A, Certified Nursing Assistant (CNA), reported that Resident #72's tray had not been included in the cart, due to an error in the kitchen.A review of the seating arrangements confirmed that Resident #72 was assigned to table #3. This designation is part of the facility's established dining plan, ensuring residents are seated according to structured guidelines during meal services.Interview with Staff A Certified Nursing Assistant (CNA) on 07/28/2025 at 12:32 PM revealed the resident did not receive a meal during the scheduled dining period. She reported that the kitchen staff had failed to deliver Resident #72's meal tray to the dining room as expected and the oversight originated in the kitchen, resulting in the absence of the resident's meal.Interview with Director of Nursing (DON) on 07/31/2025 at 11:45 AM. She stated the resident was present in the dining room during meal service, despite not being assigned to dine in that location. This occurrence was the result of an error, and Resident # 72's presence there was unintentional.Interview on 07/31/2025 at 1:05 PM, the Food Service Director revealed the kitchen staff served meal trays based on a list provided by the charge nurse. This list indicated which residents were assigned to eat in the dining room. During tray line service, the trays were distributed according to the information specified on that list to ensure proper meal delivery. However, he was not certain about the specific events that occurred on that day. Record review of the Policy and Procedures for Residents Rights revised on 11/28/2016 revealed: Residents Rights a) The resident has a right to a dignified existence, self-determination and communication with and access to person and services inside and outside the facility including those specified in this section. 1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the residents. 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 9 Event ID: 105232 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 105232 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Maria Nursing Center 1050 NE 125th Street 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)