Health inspection·September 8, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to implement nutrition / hydration care plans that included physician orders for thickened liquids for 3 of 4 residents reviewed for dietary services, out of a total sample of 4 residents, (#4, #6, and #8). Findings: On 9/07/23 at 10:17 AM, [NAME] D stated residents' meal trays were prepared according to pre-printed diet slips that reflected the type of diet, required food texture, and consistency of fluids. She explained the kitchen stocked large, pre-mixed containers of mildly thickened water (nectar consistency) and moderately thickened water (honey consistency) from which kitchen staff dispensed the correct fluid into cups at mealtimes. [NAME] D stated if residents needed fluids between meals, nursing staff on the units would have to check diet orders in the computer to ensure they provided the right consistency. She stated nursing staff could come to the kitchen for pitchers of honey and/or nectar thickened water and keep them in the nourishment room refrigerators. [NAME] D selected diet slips for three residents who required thickened liquids for review, residents #4, #6, and #8. 1. Review of resident #8's medical record revealed he was admitted to the facility on [DATE], and most recently readmitted on [DATE]. His diagnoses included end-stage kidney disease with dependence on dialysis, type 2 diabetes, and schizoaffective disorder. The Minimum Data Set (MDS) Discharge-Return Anticipated assessment with assessment reference date (ARD) of 8/09/23 revealed resident #8 had short term memory problems and moderately impaired cognitive skills for daily decision making. He required supervision with eating and had a therapeutic diet. Resident #8's medical record included a care plan for risk for decreased nutritional status and dehydration, initiated on 7/07/23. The interventions included provide a controlled carbohydrate diet, encourage fluids, and monitor oral intake. Review of the Order Summary Report revealed a physician order dated 9/05/23 for a regular diet, regular texture, and mildly thick consistency fluids. On 9/07/23 at 10:30 AM, there was a white Styrofoam cup labeled with resident #8's room and bed number on his tray table. The 100 Unit Manager (UM) confirmed the cup was filled with regular water. On 9/07/23 at 10:50 AM, Certified Nursing Assistant (CNA) C confirmed resident #8 was on her assignment but she was not aware he required thickened water. She stated she usually asked the nurse if (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: 105307 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 105307 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Rehabilitation Center at Winter Park 2075 Loch Lomond Drive Winter Park, FL 32792 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)