Health inspection·November 18, 2021

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure 1 (Resident #197) of 22 residents reviewed, was informed, and provided written information about advance directives. The failure to provide advance directives information to the resident and/or their representative could lead to them not knowing their rights to make choices concerning health care and treatments for life sustaining measures and to ensure their wishes were honored. The findings included: On 11/16/21 a review of Resident #197's medical record revealed she was admitted to the facility on [DATE]. Further review of the medical record revealed no documentation the facility had determined Resident #197's wishes related to her advance directive. Review of Resident #197's plan of care for advance directive dated 7/31/21 noted Resident #197 did not have an advance directive. Under the intervention section, the plan noted the facility would discuss advance directives with the resident and/or their representative. On 11/17/21 review of the facility's policy titled Advance Directive SS-124, effective 10/25/2018 stated upon admission, the Social Service Director (SSD) or the Business Development Coordinator would determine whether the resident had an advance directive, if not, determine whether the resident wished to establish an advance directive. On 11/17/21 at 4:16 p.m., in an interview, the Social Service Director (SSD) confirmed as part of the SSD job duties, they or a facility staff are required to interview each resident and/or their representative upon the resident admission to the facility about the resident's advance directives wishes. The SSD reviewed Resident #197's medical record and confirmed Resident #197 was admitted to the facility on [DATE]. The SSD said she was unable to find documentation a facility representative had interviewed Resident #197 and/or a representative related to Resident #197 wishes regarding advance directive as noted in the facility's Advance Directive policy and as documented in Resident #197's care plan for advance directive dated 7/31/21. 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 5 Event ID: 105416 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 105416 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Beneva 741 South Beneva Road Sarasota, FL 34232 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)