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. Page 1 of 5 105416 105416 11/18/2021 Aviata at Beneva 741 South Beneva Road Sarasota, FL 34232

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on record review, and staff and resident interview, the facility failed to obtain dental services in a timely manner for 1 (Resident # 81) of 1 resident identified in need of dental services. Residents Affected - Few The findings included: On 11/18/21 at 10:00 a.m., in an interview, Resident #81 said the facility keeps giving him burnt grilled cheese sandwiches that are so hard, he has broken 4 teeth eating them. He said he had pain and difficulty eating some foods because of his broken teeth and has asked to see a dentist but has not seen one yet. On 11/18/21 at 2:00 p.m., record review of dental care plan for Resident #81 dated 11/26/20 revealed Resident #81 had dental discomfort. Interventions noted on the care plan included coordinating arrangements for dental care and transportation as needed. Further review of the clinical record revealed a physician's order dated 12/1/2020 for dental consult regarding severe dental impairment and pain. On 1/12/2021 there was another physician's order to please follow up with dental consult ordered on 12/1/2020 regarding severe impairment and pain. On 11/18/2021 at 3:15 p.m., The Regional Director of Nursing provided a progress note dated 2/2/21 that read, Resident refused to go to dentist appointment today d/t [due to] constipation. MOM (Milk of magnesia) administered with positive results. On 11/18/2021 at 3:15 p.m., in an interview, the Regional Director of Nursing verified she was unable to locate any further efforts made by the facility to assist Resident #81 to obtain dental care. 105416 Page 2 of 5 105416 11/18/2021 Aviata at Beneva 741 South Beneva Road Sarasota, FL 34232

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 observation and staff interview, the facility failed to maintain the kitchen and equipment in a clean, safe, and sanitary manner and in good repair with regards to unclean cooking surfaces, equipment heavily soiled, unclean surfaces near food preparation equipment. These deficient practices had the potential of spreading harmful microorganism, which could cause food borne illness to residents consuming an oral diet. The findings included: On 11/15/21 at 9:30 a.m., during an initial kitchen tour, the following was observed: The floor throughout the kitchen was heavily soiled with debris, including food particles, and other items on floors under carts and tables. The Baker's oven #1 was heavily soiled with grime and debris. Photographic evidence obtained The exterior sides of the baker's oven #1 were soiled with food spillage and grime. Photographic evidence obtained The vents over baker's oven #1 were heavily soiled with debris, grime, and black bio growth. Dust was hanging over the food being prepped for lunch meal on the top of the oven. Photographic evidence obtained The walls behind the baker's oven were soiled with grime. Photographic evidence obtained The tilt skillet was heavily soiled with grime and debris. Photographic evidence obtained The rack in the toaster was heavily soiled with grime. The stacking rack with nesting domes was soiled with grime and debris. Photographic evidence obtained The entry wall to the dish washing area was heavily soiled. The floor cover base had chipped tiles. Photographic evidence obtained Utility service carts were heavily soiled with grime and debris. 105416 Page 3 of 5 105416 11/18/2021 Aviata at Beneva 741 South Beneva Road Sarasota, FL 34232

F 0812 Photographic evidence obtained Level of Harm - Minimal harm or potential for actual harm The shelves under the stove were heavily soiled with grime. The sink in the nourishment room at Nurses' station #1 was heavily soiled with grime and rust. Residents Affected - Many Photographic evidence obtained The wall behind the sink in the nourishment room at Nurse's station #1 was soiled with grime and black bio growth. Photographic evidence obtained The microwave in nourishment room at nurses' station #1 was soiled with grime, and food spillage. Photographic evidence obtained On 11/16/21 at 9:11 a.m., during a tour of the kitchen the baker's oven #2 was observed heavily soiled with grime and debris. The vents over baker's oven #1 were still heavily soiled with debris, grime, and black bio growth. Dust was hanging over the food being prepped for lunch meal on the top of the oven. The walls behind the baker's oven were soiled with grime. On 11/16/21 at 9:20 a.m., in an interview Dietary manager staff J, confirmed the baker's ovens were heavily soiled with grime and debris, the vents were soiled with grime and debris with hanging dust over uncovered food being prepared to be served with the lunch meal. Staff J confirmed the ovens and the kitchen needed cleaning. Staff J stated, I guess I'll be cleaning them today. On 11/17/21 at 11:45 a.m., during tray line, observed kitchen staff preparing utility service carts with lunch meals being transported to the 400, 300 and 200 units for service to residents. The carts were soiled with debris, grime, and residue of food spillage. On 11/17/21 at 12:15 p.m., the juice machine dispensing pour spout was observed hanging and laying on the edge of a shelf with debris, in close proximity to the floor in an unsanitary manner. Photographic evidence obtained On 11/17/21 at 12:17 p.m., in an interview dietary manager Staff J and Staff K, confirmed utility service carts were dirty and needed to be cleaned. Staff K confirmed the juice dispenser spigot needed to be kept in the container on the counter and not hanging down near the floor as it is then contaminated. On 11/17/21 at 12:52 p.m., during observation of distribution of lunch on the 400-hall unit from the utility service carts, Certified Nursing Assistant (CNA) Staff I confirmed in an interview the service cart was dirty and stated, the cart is filthy dirty and needs to be cleaned. On 11/18/21 at 12:07 p.m., during a tour of nourishment room at nurses' station #1 with the Maintenance Director, he confirmed in an interview the sink was heavily soiled with grime and rust and the 105416 Page 4 of 5 105416 11/18/2021 Aviata at Beneva 741 South Beneva Road Sarasota, FL 34232

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many wall behind sink was soiled with grime and black bio growth. The Maintenance Director said it was the responsibility of housekeeping to clean the nourishment room. On 11/18/21 at 12: 10 p.m., during a tour of nourishment room at nurses' station #1, with Environmental Services Staff N, she confirmed the sink was heavily soiled with grime and rust and the wall behind the sink was soiled with grime and black bio growth. *Photographic evidence obtained* 105416 Page 5 of 5