Health inspection·October 12, 2023

F 0565 laundry issue related to returning items in a timely manner. Level of Harm - Minimal harm or potential for actual harm There was no documentation that the facility addressed the concerns voiced by the resident council group. Residents Affected - Some Review of a Resident Council Minutes form dated 6/5/23 revealed 14 residents attended the meeting and voiced concerns related to food, provide residents with alternative menu when requested. The form documented the issue was partially resolved. Missing laundry, return all items within 2-3 days - not resolved. Review of a Resident Council Meeting form dated 7/3/23 revealed 14 residents attended the meeting. The concerns included missing laundry. The residents would like laundry back in two to three days. This marked as partially resolved. Concerns related to dietary, providing residents with requested alternatives when requested was marked as not resolved. No Resident Council Meeting was held for the month of August 2023. Review of Resident Council Minutes form dated 9/11/23 revealed 9 residents attended the meeting and the following concerns were not resolved: Food and dietary, don't always get our selection. Confused residents going in and out of other rooms, residents want them to be kept out. Concerns for missing clothes. Review of Resident Council Minutes form dated 10/9/23 revealed 13 residents attended the meeting and the following concerns were not resolved: Food half cooked, meals cold when served, do not follow special orders that residents request, cereal served without milk, dietary staff do not give resident cream/sugar/salt and pepper when requested. Items that are posted on the menu are not what they receive. Housekeeping/Laundry, getting back clothes in a timely manner to resident and making sure every item is labeled with resident name. On 10/10/23 at 10:30 a.m., a meeting was held with nine Resident Council members, including Resident #5, #6, #12, #23, #33, #43, #64, #67, and #72. The meeting minutes of the last six months were discussed. The residents all said the issues brought up in resident council in the past six months had not been resolved, the issues continued. The residents stated the food and dietary issues, and the missing cloths from the laundry were a continuing problem that were either partially resolved or not resolved. On 10/11/23 at 3:15 p.m., the Activity Director said she started employment at the facility a couple of weeks ago and held her first Resident Council Meeting this month. She said she gives the minutes to the Administrator for her review. The Administrator distributes the concerns to the appropriate (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 2 of 25 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 10/12/2023 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)

F 0565 staff member to address. Level of Harm - Minimal harm or potential for actual harm On 10/12/23 at 1:12 p.m., the Administrator said the Activities Director brings the meeting minutes to her. She directs the concerns to the appropriate department and gives them a certain amount of time to look into the concerns and resolve them. The resolutions should be brought back to the resident council to see if they have seen any improvement. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 3 of 25 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 10/12/2023 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on record review and staff interview the facility failed to ensure a comfortable environment for 1 (Resident #59) of 2 residents sampled for missing property in that they failed to exercise reasonable to minimize the loss of personal property. The findings included: Review of the facility's document titled Personal Property Loss or Theft, dated 11/30/14 read, The center has processes to minimize the risk of loss or theft of residence personal property. At admission resident's belongings will be identified and recorded . An employee receiving a concern regarding lost or missing items from a resident or resident representative will initiate a Complaint /Grievance form or electronic equivalent .The center will track frequency and patterns of lost items and will initiate with the Executive Director contact with the Police Department where deemed appropriate . On 10/9/23 at 8:30 a.m., Resident #59 said her clothes are always missing. She reports it to the Housekeeping Supervisor all the time. A review of the facility's complaint, and grievance report revealed Resident #59 filed a complaint related to missing property on 3/4/23, 9/11/23 and 10/1/23. Review of the Nursing Progress Note dated 8/27/23 documented CNA (Certified Nursing Assistant) notified this writer the Resident stated she is missing 2 packages of cigarettes. On 10/10/23 at 8:21 a.m., Resident #59 said Resident #40 wanders around the facility and takes other people's things. She said, Yesterday she had my clothes on. On 10/10/23 at 8:25 a.m., Certified Nursing Assistant (CNA) Staff E said the day before, she observed Resident #40 wearing Resident #59's shirt and pants. Staff E said, It happens all the time. I don't know what laundry is doing. They are always delivering the wrong clothes to other residents' rooms. I try to look for things if my residents said they are missing something, I will go and check for myself. On 10/10/23 at 8:30 a.m., Resident #59 said Resident #40 goes into other residents' rooms. She said, It does not matter if you have your door closed, it doesn't stop her. She said the facility placed a lock on the drawers of the nightstand to keep Resident #40 out. She said, I have told the Director of Nursing, the Administrator and the nurse but nothing is done about her, she wanders all day long. On 10/10/23 at 1:38 p.m., Resident #59 was observed at the nursing station. Resident #59 was telling CNA Staff E Resident #40 was wearing her clothes again. CNA Staff E verified Resident #40 was wearing Resident #59's clothes. On 10/10/23 at 3:58 p.m., Unit Manager Staff D said he was not aware Resident #59 had reported missing items. Staff D said Resident #40 wanders and goes into other residents' rooms and takes things. Staff D said, We try to redirect Resident #40, she is confused with dementia, and there is nothing we can really do. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 4 of 25 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 10/12/2023 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete On 10/12/23 at 8:30 a.m., the Director of Nursing (DON) said Resident #59 tells stories about missing items. She said she was not aware CNA Staff E had observed Resident #40 wearing Resident #59's clothes. On 10/12/23 at 12:44 p.m., further review of the Grievance Log failed to show facility representatives initiated a Complaint/Grievance to address Resident #59's concerns related to the missing clothing. Event ID: Facility ID: 105416 If continuation sheet Page 5 of 25 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 10/12/2023 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)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, staff and resident interview, the facility failed to provide the necessary care and services to maintain personal grooming and hygiene for 2 (Residents #32, and #74) of 2 residents reviewed who require assistance with activities of daily living. Residents Affected - Few The findings included: The facility Policy titled showering and bathing with a revision date of 9/01/2017, stated Assistance with showering and bathing will be provided at least twice a week and PRN (as needed) to cleanse and refresh the resident. 1. Record review revealed Resident #32 was admitted to the facility on [DATE]. The diagnoses included Dementia, and Muscle Weakness. Resident #32's care plan initiated 12/13/22, included the intervention/task of bathing and showering: check nail length and trim and clean on bath day and as necessary. On 10/9/23 at 10:01 a.m., Resident #32 was observed in bed, wearing a hospital gown with facial hair growth of approximately seven days. The resident's fingernails extended approximately half inch from the nail beds and had an accumulation of brown substance underneath the fingernails. Resident #32 said, I need a shave and a haircut too. On 10/10/23 at 2:50 p.m., and 10/11/23 at 8:35 a.m., Resident #32 was observed in bed. He remains unshaved. His fingernails remained untrimmed with a black substance underneath the nails. On 10/10/23 at 3:55 p.m., Certified Nursing Assistant, (CNA) Staff X said, showers are done twice a week. We shower them, clean them up, get them dressed if they want. We do their hair and nails. On 10/11/23 at 11:30 a.m., Registered Nurse (RN) Staff D verified Resident #32's nails extended more than half an inch and were dirty. She said Resident #32 needed to be shaved daily. On 10/11/23 at 11:50 a.m., during a joint observation of Resident #32, the Regional Director of Clinical Services stated they expected everyone to receive Activities of Daily Living (ADL) care. If a resident refused care, it would be documented. Resident #32 said, It's been a couple of weeks since he has been shaved. On 10/11/23 at 3:06 p.m., CNA Staff C said she was assigned to Resident #32, and he did not refuse care. On 10/12/23 at 4:00 p.m., the Administrator said, I don't know what the policy is, I would like to think that shaving and nail care are part of daily grooming, and the resident would be asked if they would like to be shaved. 2. Record review revealed Resident #74 was admitted to the facility on [DATE]. The diagnoses included Cerebral infarction (Stroke), muscle weakness, unsteadiness on feet, repeated falls. Resident #74's care plan initiated on 7/5/23 indicated the resident required extensive assistance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 6 of 25 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 10/12/2023 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)

F 0677 by one staff person for bathing, showering, dressing, personal hygiene, and oral care. Level of Harm - Minimal harm or potential for actual harm On 10/10/23 at 10:07 a.m., Resident #74 was observed in bed eating breakfast. Resident #74's fingernails extended half an inch from the nail beds and had approximately seven days of facial hair growth. Resident #74 rubbed his face and said, I need a shave. When asked if he gets showered or bathed, Resident #74 said, occasionally. Residents Affected - Few On 10/11/23 at 8:41 a.m., Resident #74 was observed in bed on back, wearing hospital gown, nails are long, beard is long. Resident #74 said, it's been some time since he's been shaved. On 10/11/23 at 11:10 a.m., Resident #74 was observed in bed lying with his head over one side of the bed and his legs over the other side of the bed. He was not wearing clothes or underwear. Registered Nurse (RN) staff D entered the room and verified the resident was not dressed or wearing underwear. RN, Staff D verified the resident's nails extended approximately half inch from the nail bed and had approximately seven days of facial hair growth. RN Staff D asked a CNA to shave the resident and trim his nails after lunch. RN Staff D did not offer clothes to the resident and did not instruct the CNA to assist the resident with underwear and clothes. On 10/11/23 at 1:45 p.m., The Regional Director of Clinical Services said, we will get him taken care of. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 7 of 25 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 10/12/2023 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)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. On 10/10/23 at 9:45 a.m., during an interview with Resident #96, she said she was admitted to the facility on [DATE] after having hip surgery. She said when she was admitted to the facility, she had a wound vac to the surgical site which was stapled together. The wound-vac stopped working and the wound care nurse discontinued the wound-vac the next day and left the staples intact at the surgical site. After several days she said she asked the wound care nurse when he would remove the staples from the surgical site, and he told her the surgical site was red and the staples could not be removed at that time. Residents Affected - Some Resident #96 said she kept asking the wound care nurse and the floor nurses when the staples would be removed, when was her follow-up appointment with the surgeon and when would her primary care physician (PCP) be coming to the facility to see her. She said the nursing staff told her they did not know when the staples would be removed, and they did not know when her follow-up appointment would be with the surgeon. She further said when she asked the wound care nurse last week when her follow-up appointment was with the surgeon, he told her she was responsible for calling the surgeon and making the follow-up appointment with the surgeon. She said she did not think the surgeon's office, the facility, and her PCP were communicating with each other to address the removal of the staples to the surgical wound site. A review of Resident #96's medical record revealed she was admitted to the facility on [DATE] after a joint replacement surgery to the left hip. A physician's order dated 9/21/23 stated to remove the left hip wound vac on 9/27/23 and call the surgeon's Nurse Practitioner (NP) to arrange for a follow-up visit with the surgeon. A review of a Weekly Skin Integrity Review form dated 10/1/23 stated the left thigh (rear) surgical site was red with drainage. The Weekly Skin Integrity Review form dated 10/5/23 stated the left trochanter post-surgical site measures 17 x 0.1 x 0.1 centimeters (cm) with 100% epithelial tissue. The Weekly Skin Integrity Review form dated 10/8/23 noted staples to the left hip but did not identify the number of staples in the incision. The Admission/readmission Data Collection form dated 9/21/23 stated Resident #96 had a left trochanter wound vac. A Surgical & Wound Care progress note dated 10/5/23 noted the wound care physician was asked to see Resident #96 for his opinion on how to manage the patient's wounds. The wound care physician wrote the left hip surgical site wound had erythema (redness) and edema (swelling). He recommended Doxycycline (antibiotic) 100 milligrams (mg) twice a day for 10 days; cleanse the wound with 0.125% Dakins Solution, apply betadine, and change the dressing every day and as needed. Further review of the wound care physician's progress note revealed no documentation of the staples to the left hip surgical site. A review of a nursing progress note dated 9/21/23 stated Resident #96's left hip wound vac was in place, clean, dry, and intact. A nursing progress note dated 10/5/23 stated the nurse attempted to call the surgeon's Nurse Practitioner (NP) for a follow-up appointment for when the wound vac was originally scheduled to be discontinued. The wound care nurse was made aware of the attempt to contact the surgeon's NP. The progress notes further stated Resident #96 was seen by the wound care physician at the bedside and Resident #96 was started on ABT (antibiotic therapy) prophylactically for the left hip surgical site. A review of the nursing progress notes dated 10/6/23, 10/7/23, and 10/8/23 stated the nurse called (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 8 of 25 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 10/12/2023 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)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the surgeon's NP for a follow-up appointment when the wound vac was scheduled to come off, and that Resident #96 was being seen by the Wound Care Physician. A review of the Notification of Change in Condition policy and procedure #N-105 effective 11/30/14 and last revised 12/16/20, stated The Center to promptly notify the Patient/Resident, the attending physician, and the Resident Representative when there was a change in the status or condition .The nurse to notify the attending physician and Resident Representative when there is a (n) .a need to alter treatment significantly, new treatment, discontinuation of a current treatment due to but not limited to adverse consequences, acute condition, and exacerbation of chronic condition. On 10/12/23 at 11:21 a.m., in an interview with the Wound Care Physician, he reviewed his 10/5/23 progress note. He confirmed he was asked by the wound care nurse to evaluate Resident #96's left hip surgical site for his opinion on how to manage Resident #96's surgical wound. He confirmed he wrote the left hip, surgical site wound had erythema and edema, and he recommended Doxycycline 100 mg twice a day for 10 days and a treatment for the surgical site. The wound care physician said he did not believe Resident #96 had staples to the surgical site at the time of his assessment because he did not document the staples in his progress note. On 10/12/23 at 11:35 a.m., in a second interview with the Wound Care Physician said he was informed by the Wound Care Nurse, that Resident #96's left hip surgical wound staples were removed yesterday (10/11/23) by the surgeon. He said he was asked by the Wound Care Nurse to look at Resident #96's surgical site but did not know if the facility and/or the Wound Care Nurse had informed Resident #96's PCP and/or the surgeon the facility had requested his evaluation and treatment of Resident #96's surgical site. On 10/12/23 at 1:17 p.m., in an interview with the Wound Care Nurse, he confirmed Resident #96 was admitted to the facility on [DATE] with a wound vac to the left hip surgical site with staples. He said the wound vac stopped working on 9/22/23 so he discontinued the wound vac and tried to call the surgeon's NP several times but was unable to reach them.? He confirmed he asked the Wound Care Physician to evaluate Resident #96's surgical wound for possible treatment orders. He said he was unable to find documentation he and/or another facility staff had informed Resident #96's surgeon and/or Resident #96's PCP the wound vac had stopped working on 9/22/23 and the facility had asked the Wound Care physician on 10/5/23 to conduct an evaluation of Resident #96's surgical wound site. On 10/12/23 at 2:07 p.m., in an interview with the Director of Nursing (DON), she said the facility's policy stated the nurse was required to inform a resident's primary care physician for any change in resident status. She confirmed Resident #96 was admitted on [DATE] with a left hip surgical site with staples and a wound vac. She said Resident #96 had an order which stated when the wound vac was discontinued to call the surgeon to arrange for a follow-up visit. The DON said after reviewing all of Resident #96's medical records, the wound vac stopped working on 9/22/23 and there was no documentation the facility staff called the surgeon and/or Resident #96's PCP to inform them the wound vac had stopped working. She said she noted the nursing staff had called and left a message for the surgeon's NP on 10/5/23 which was 14 days after the wound vac had stopped working. She further said they had no documentation Resident #96's surgeon was informed the Wound Care physician was asked to evaluate the surgical site and an ABT was ordered for Resident #96's surgical wound. She said the facility staff did not follow their Notification of Change policy as required when they did not notify the surgeon and/or Resident #96's PCP on 9/22/23 when the wound vac was discontinued because it was not working and when they asked the Wound Care physician to evaluate and treat Resident #96's surgical wound care site due to the surgical wound site had erythema and edema for which the wound care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 9 of 25 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 10/12/2023 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)

F 0684 physician prescribed a new treatment order and ABT for 10 days. Level of Harm - Minimal harm or potential for actual harm Based on observation, review of facility policies and procedures, record review, staff and resident interviews, the facility failed to demonstrate effective coordination to ensure 3 (Resident #37, #96 and #399) of 3 resident's reviewed received appropriate medical care and treatment. Residents Affected - Some The findings included: The facility policy and procedures for Self-Administration of Medication at Bedside dated 11/30/14 noted, the resident may request to keep medications at bedside for self-administration in accordance with resident rights. Criteria must be met to determine if a resident is both mentally and physically capable of self-administering medications and to keep accurate documentation of these actions. Procedure: Verify physicians order in the residence chart for self-administration of specific medications under consideration. Complete a self-administration of medication evaluation. Complete the care plan for approved self-administrated drugs The MAR (medication administration record) must identify meds that are self-administered, and the medication nurse will need to follow up with the resident as to documentation and storage of medication during each med pass. If it is kept at bedside the medication must be kept in a locked drawer. 1. Review of the clinical record revealed Resident #399 was admitted on [DATE] with diagnosis including chronic obstructive pulmonary disease (COPD), chronic kidney disease, atrial fibrillation, and anxiety. On 10/9/23 at 10:47 a.m., Resident #399 said he was not receiving all of his medications and the nurse tells him it is because they are not able to reach the physician. He said he came from the assisted living facility (ALF) side of the facility to the hospital and was admitted to the skilled nursing facility. Resident #399 said he was not receiving the medications he needed to treat his COPD. Resident #399 had a nebulizer (a device that turns liquid medicine into a mist which is inhaled) on the nightstand next to his bed. Resident #399 said the nebulizer here works but no one takes care of it, and they were not giving him the medication he needed. The resident said, I have told every nurse who walks in this room, I need my nebulizer, I have COPD and asthma. I can't breathe right. I keep getting the same answer, the doctor has to order it. The resident said, How hard is it to call the man and get an order? I'm ready to check myself out of here and walk next door to the ALF and have my medication. Further review of the clinical record revealed there was no order for a nebulizer or medication for the nebulizer. On 10/10/23 at 9:09 a.m., Resident #399 said he still had not received the nebulizer treatment. He said he asked someone to go the ALF where he resides and bring the medication to him. He was self-administering the nebulizer treatment but only had one vial left. The resident said he used it four times a day. Resident #399 said he will have to have someone go to the ALF and get him more medication. He said I had a friend go there last week to my apartment and bring me the medication. I have reported it to the nurse every day and they tell me I can't get it because they have not reached the physician yet. I have been here for days, and you're telling me no one has looked at my record? Resident #399 showed a vial of nebulizer medication to the surveyor, placed the liquid medication into the nebulizer cup and turned the machine on. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 10 of 25 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 10/12/2023 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)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 10/10/23 at 4:17 p.m., the Unit Manager Staff D said he knew Resident #399 had a nebulizer in his room but was not receiving any medication. The Unit Manager checked the residents electronic record and said he did not have an order for the nebulizer. He said Resident #399 had his previous roommate go to the ALF and get his backpack, I guess he had it in there. He has not received any medication in the nebulizer. The observation of Resident #399 self-administering a nebulizer treatment was shared with Staff D. Staff D said Resident #399 really did not require skilled nursing and would probably return to his room in the ALF tonight or tomorrow anyway. Staff D said he would let the physician know Resident #399 was requesting nebulizer medication. On 10/11/23 at 9:15 a.m., Resident #399 said he had COPD, allergies, was coughing and needed his nebulizer treatment. He said the physician ordered the medication last night, but he still has not received it. On 10/11/23 at 9:21 a.m., Unit Manager Staff D verified the physician ordered the medication last night and it arrived from the pharmacy. Staff D said he would make sure the resident gets the medication. On 10/11/23 at 1:10 p.m., a review of the MAR showed a physician order for Ipratropium-Albuterol solution 0.5-2.5 (3) mg/3ml via nebulizer every 6 hours as needed for shortness of breath. On 10/11/23 at 4:46 p.m., the Director of Nursing (DON) said she was unaware Resident #399 had a nebulizer and was self-administering the respiratory treatment in his room. The DON said the physician ordered the medication the day before. 3. Review of the medical record revealed Resident #37 was admitted on [DATE] with diagnoses including aftercare following joint replacement surgery and presence of right artificial hip joint. Review of the Order Summary Report revealed an antibiotic order for Ceftriaxone Sodium Intravenous (IV) solution 2 grams, use intravenously from 9/26/23 until 11/1/23. Review of the Medication Administration Records (MARs) for September and October 2023 revealed the antibiotic was being administered through the IV each day at 1:00 p.m. starting on 9/26/23. On 10/10/23 at 11:52 a.m., observed Resident #37 in bed, left arm exposed. IV dressing to left inner arm had a hand-written date of 9/23/23. There was a brown substance under the transparent dressing where the catheter entered the resident's arm. Resident #37 said the IV dressing had not been changed since the hospital put it in. Photographic evidence obtained. Review of the MARs for September 2023 did not include orders to change the IV dressing. Review of the Order Summary Report revealed orders for IV catheter dressing change on 10/9/23: Change Dressing on admission or 24 hours after insertion and weekly there after and prn (as needed). Review of the MARs for October 2023 revealed the IV dressing change was completed on 10/10/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 11 of 25 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 10/12/2023 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)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete On 10/11/23 at 10:15 a.m., observed Resident #37 in bed. The IV dressing had not been changed as the October MAR indicated, and the date was still 9/23/23. The brown substance was still under the transparent dressing and the dressing was peeling away from the skin in one corner. The Director of Nursing (DON) was in the room at the time and said the IV dressing was outdated and should have been changed. On 10/12/23 at 10:28 a.m., Registered Nurse Staff D said he was the certified Infection Preventionist for the facility. He said Resident #37 has a mid-line IV catheter, but he was not aware the dressing was outdated. He said the nurse should have checked with the doctor and included the IV dressing changes when the resident returned on 9/25/23. He said the midline IV needs to be changed when resident is admitted or within 24 hours and then each week or seven days thereafter. Event ID: Facility ID: 105416 If continuation sheet Page 12 of 25 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 10/12/2023 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident and staff interviews, and facility policy review the facility failed to ensure appropriate assessment, documentation, and monitoring after a fall incident for 1 (Resident #25) of 7 resident reviewed for accidents. The facility also failed to ensure safe smoking practices for 1 (Resident #19) of 7 residents reviewed for accident. The findings included: A review of a facility policy titled; Fall Management last revised on 7/29/19 specified: C. Post Fall Strategies 1. Resident will be evaluated, and post fall care provided 2. Initiate Neurological checks as per policy or directed by physician order 3. Notify the physician and resident representative 4. Re-evaluate fall risk utilizing the Post Fall Evaluation 5. Update Care Plan and Nurse Aide Kardex with interventions 6. Initiate post fall documentation every shift for 72 hours 7. Interdisciplinary Team to review fall documentation and complete root cause analysis 8. Update plan of care with new interventions as appropriate 9. Review resident weekly x4 A review of a facility policy titled; Resident Incident/Accident Reports last revised on 8/24/17 specified: Procedure: Any happening not consistent with routine operations of the facility or care of a resident may warrant the completion of an incident report. Following nursing assessment, the physician will be notified of any noted or suspected injury and will implement appropriate interventions. The event, along with assessment, physician and other required notification will be documented in the clinical record. Resident's family or representative will be notified of event. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 13 of 25 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 10/12/2023 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)

F 0689 Incidents will be noted on the 24-hour report. Level of Harm - Minimal harm or potential for actual harm Incident reports shall be reviewed by the Director of Nursing for completion and follow-up. Residents Affected - Few A review of an admission Record indicated Resident #25 was admitted on [DATE] with the following diagnosis: chronic obstructive pulmonary disease, depression, right and left shoulder pain, muscle weakness, lack of coordination, history of falls, dyspnea (shortness of breath), chronic pain, spinal stenosis in the thoracic region, overactive bladder, and Macular degeneration (poor eyesight). The quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #25 had a Brief Interview for Mental Status (BIMS) score of 14 which indicated the resident was cognitively intact. Resident is independent in bed mobility and transfers she can walk in her room with supervision of one person. The resident also needs supervision of one person when using the bathroom. Pain assessment revealed the resident had frequent pain on a scale of five (5) on a scale of 1-10. The resident was coded as having a history of falls. During an interview on 10/09/23 at 10:12 a.m., Resident #25 stated that she was having a lot of pain in her left and right shoulders, and she was waiting on her medication. Resident was alert and oriented sitting up in her wheelchair at bedside. On 10/10/23 at 9:57 a.m., Resident #25 was observed with a large egg-shaped purple bruise on her right lateral forearm and a half dollar size purple bruise on the lateral right upper arm. These bruises were not noted yesterday when resident was interviewed. During an interview on 10/10/23 at 9:59 a.m., Resident #25 stated she fell the night before. She had been placed in the bathroom. She wanted to go back to bed so she tried to go back by herself and fell. She said she could not make it all the way and fell to the floor next to the bed. The resident stated she yelled out for help for about one and a half hours before anybody came to help her. The resident said the bedroom door was open. She did not understand why the staff took so long to respond to her yelling for help. She said she was very cold and had to reach to her bed, pull down her blanket to cover herself and keep warm. They did not come to get her for a long time. She said she thinks she also hit the side of her head. Review of the nursing progress notes for 10/10/23 and 10/11/23 failed to document a fall for Resident #25. On 10/11/23 at 11:13 a.m., Resident #25 stated that she was on the floor so long. She said finally Licensed Practical Nurse (LPN) Staff Y lifted her off the floor, placed her in a chair and then into bed. He got her a pain pill and then she was comfortable. She said no one helped Staff Y, not even a Certified Nursing Assistant, and they did not use a lift to get her off the floor. During an interview on 10/11/23 at 11:47 a.m., LPN Staff Y stated he last worked on Monday into Tuesday morning. The nurse stated he works 12-hour shifts from 7:00 PM to 7:00 AM the next day. LPN staff Y stated nothing outstanding happened on his shift such as a resident fall or medical issues. The nurse stated he did not recall any resident yelling or calling out. LPN Staff Y said if a resident sustained an unwitnessed fall, he would be doing neurological checks and monitor the vital signs. When asked about Resident #25's fall, LPN Staff Y said when he came into the resident's room at approximately 5:00 a.m., she was sitting in her wheelchair at bed side. She told him she had been on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 14 of 25 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 10/12/2023 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the floor for hours. She got up by herself and could not remember if anyone helped her off the floor. The resident said she wanted to go back to bed so he picked her up to put her in bed. The bed was not locked and started to move, so he placed the resident on the floor, locked the bed, picked her up from the floor and put her in bed. He gave her a pain pill and she said she was fine. Staff Y said no one helped him put the resident back to bed. He did not document or report the incident to the oncoming shift since the resident said she was fine. When he did he last rounds, she was sleeping and was doing fine. On 10/11/23 at 12:21 p.m., the Director of Nursing (DON) said even if a resident is lowered to the floor, she considered that a fall, and it needs to be reported. The DON said the staff member should assess the resident for injuries, get assistance to get the resident off the floor, pass it on to the next shift. She said she would expect the nurse to obtain vital signs, do neurological checks. The DON said she was not aware of the incident involving Resident #25. She said Staff Y did not act appropriately and she would investigate the incident. Review of the Medication Administration Record (MAR) for October 10 failed to show documentation Resident #25 was medicated for pain as per Resident #25, and Staff Y's interview. Review of the declining inventory of the controlled substance sheets failed to reveal documentation Resident #25 received the ordered Hydrocodone and Tylenol on 10/10/23. There were no vital signs documented in the clinical record for 10/10/23 after the fall. Review of the facility policy for Smoking - Supervised, revision dated 2/7/20, The Center will provide a safe, designated smoking area for residents. For the safety of all residents, the designated smoking area will be monitored by a staff member during authorized smoking times. Smoking is only allowed in designated areas and during designated times. #4. During designated smoking times, staff will be assigned to assist or supervise residents. #5. The Center will retain and store matches, lighters, etc. for all residents. Review of the medical record for Resident #19 revealed an admission date of 3/19/21 with diagnoses including cerebral infarction, seizures, anxiety, major depressive disorder, and schizoaffective disorder, depressive type. Review of the Smoking Agreement signed by Resident #19 on 3/19/21 revealed Residents are not to smoke in the absence of smoking attendant. On 10/9/23 at 12:00 p.m., Resident #19 said she keeps her cigarettes and lighter. She said they are her personal property, and she has the right to keep them with her. She said she keeps the cigarettes and lighter in her purse and was going outside to smoke. On 10/9/23 at 12:10 p.m., observed Resident #19 sign herself out at the front desk, wheel herself out the front door, and onto a small grassy area to the left. Resident #19 took her cigarette and lighter out of her purse, lit the cigarette and began to smoke. Two additional residents were observed smoking in the area at the time. There was no staff outside with the residents at the time of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 15 of 25 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 10/12/2023 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)

F 0689 observation. Level of Harm - Minimal harm or potential for actual harm On 10/11/23 at 9:06 a.m. Resident #71 said he was always allowed to keep his own cigarettes and lighter in his room. He said on Monday or Tuesday, they collected all the cigarettes and lighters from the residents. Residents Affected - Few On 10/12/23 at 1:51 p.m., Resident #19 said the facility tried to take away her cigarettes and lighter, but she refused to give them up. On 10/12/23 at 2:33 p.m., Registered Nurse, Staff D confirmed he tried to collect the lighters from the residents on Monday. He said Resident #19 refused to give the lighter to him. He said he informed the Nursing Home Administrator (NHA). On 10/12/23 at 2:46 p.m., Certified Nursing Assistant Staff AA said Resident #19 refused to give her lighter to the facility and lights her own cigarettes. She said the facility needs to keep the cigarettes and lighters for all the residents, because if residents have their cigarettes they will smoke in their rooms. She said she could not remember dates or residents, but she is aware some residents have been caught smoking in their rooms. On 10/12/23 at 5:39 p.m., the Nursing Home Administrator said Resident #19 keeps her own cigarettes and lighter because she refuses to give them up. She said it is a problem. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 16 of 25 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 10/12/2023 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)

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interviews and record review the facility failed to provide care and services consistent with professional standards of practice by failing to ensure ongoing, and accurate assessment upon return from the dialysis center for 1 (Resident #29) of 2 dialysis residents reviewed. Residents Affected - Few The findings included: The facility policy titled, Coordination of Hemodialysis Services N-1359, with an effective date of 11/30/2014 and a revision date of 7/2/2019, stated residents that required an outside ESRD (End Stage Renal Disease) facility would have services coordinated by the facility. The Dialysis Communication form would be initiated by the facility and sent to the ESRD center. The nurse would collect and complete the information regarding the resident to send to the ESRD center and upon the resident's return to the facility, the nurse would review the Dialysis Communication form and the information sent by the ESRD center and complete the post dialysis information on the Dialysis Communication form and file it in the resident's medical record. A review of the medical record revealed Resident #29 was admitted to the facility on [DATE] with a medical diagnosis of End Stage Renal Disease (ESRD). Resident #29 had a physician's order for hemodialysis (treatment to filter wastes and water from the blood) every Tuesday, Thursday and Saturday related to ESRD. The care plan for dialysis revised on 7/19/23 noted the resident was readmitted from the hospital with a central venous catheter dialysis access site to the right upper chest. The intervention dated 7/19/23 was not appropriate for the central venous catheter dialysis site and included to check the AV (Arteriovenous) shunt (connection of an artery to a vein) as ordered for bruit (Whooshing sound) and thrill (vibration caused by blood flowing). On 10/09/23 at 3:09 p.m., Resident #29 was observed in bed with a central catheter covered with a gauze dressing to the right side of his chest. Resident #29 said he received dialysis through the right chest catheter, but the facility staff do not routinely check it when he returns from the dialysis center on Tuesdays, Thursdays, and Saturdays. He said he used to take a communication notebook back and forth, but no one was writing in it. Resident #29 said the facility nurses do not check his blood pressure or the catheter access site upon return from the dialysis center. Review of the dialysis communication form utilized by the facility revealed a section to be completed by the facility nurse prior to dialysis and upon return from the dialysis center. Resident #29's communication forms were located in a binder at the nurse's station. The binder contained a total of eight forms from May 2023 through October 11, 2023. 15 forms were missing. The forms in the binder were incomplete and lacked documentation Resident #29's dialysis access site was assessed, or vital signs obtained upon return from the dialysis center on 5/23/23, 5/25/23, 6/1/23, 6/8/23, 8/15/23, 8/31/23, and 10/11/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 17 of 25 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 10/12/2023 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)

F 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the Treatment Administration Record (TAR) for September, and October 2023 showed documentation the facility assessed the hemodialysis site to the left upper arm for bruising/bleeding and symptoms of infection every shift when the access site was located to the resident's right upper chest. On 10/12/23 at 9:21 a.m., the Director of Nursing said the vital signs should be assessed pre and post visit and a form should be completed for each dialysis visit. She verified the resident's dialysis access site was located to the right upper chest and the documentation in the TAR was inaccurate. The Director of Nursing reviewed the clinical record and said she could not locate documentation Resident #29's vital signs were assessed upon return from the dialysis center on Tuesdays, Thursdays, and Saturdays. She could not locate documentation the facility assessed the dialysis access site to resident's right upper chest for symptoms of complications, including bleeding. Event ID: Facility ID: 105416 If continuation sheet Page 18 of 25 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 10/12/2023 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)

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the clinical record showed Resident #41 had a readmission on [DATE] with diagnoses including muscle wasting, convulsions, tremors and altered mental status. The 5-day Minimum Data Set (MDS) (standardized assessment tool that measures health status in nursing home residents) with an assessment reference date of 9/29/23 documented Resident #41 required extensive assistance of two persons for bed mobility. Review of the clinical record showed a side rail evaluation dated 5/9/23 for Resident # 41 under alternate interventions listed trapeze, raised perimeter mattress, therapy referral for bed mobility, restorative for bed mobility, bed placement, assistive device at bedside (walker, w/c, etc.) additional pillows, body bolster, low bed and other. The only checked box was for therapy. The evaluation recommended side rails x's 2, before the therapy screen was completed. Random observations on 10/9/23 at 10:43 a.m., and 10/10/23 at 8:14 a.m., Resident #41 was observed in bed with 1/4 side rails in the raised position on both sides of the bed. The resident said he did not ask for the siderails but did use them from time to time. Resident #41 had multiple bruises on his arms and a dressing was wrapped around his left wrist. Resident #41 said he said he was on two blood thinners and had hit his arm on the siderail and got a skin tear. On 10/10/23 at 4:04 p.m., in an interview Unit Manager Staff D, said the process for the siderails was for therapy to do an evaluation to see if the resident can safely use them, and if they pass the test, then we notify maintenance and they put them on the bed. Staff D said Resident #41 has resided in the facility for several years and has had the side rails for as long as I can remember. On 10/11/23 at 11:00 a.m., in an interview the Director of Nursing (DON) said she completed the Side Rail Evaluation form on 5/9/23 for Resident #41. The only intervention checked on the form specified Therapy referral for bed mobility. The DON said I was told all we had to do is refer the resident to therapy and I did. I do not know what alternate interventions they had tried. On 10/11/23 at 1:21 p.m., in an interview, the Therapy Director said we do not do side rail screens per say as part of our therapy evaluations. If the facility requests a screen, we will do it but all we really have is a trapeze and most of the residents lack the upper body strength to use it. Our main focus with side rails is to see if the resident is able to use them to reposition, move, sit up or transfer. That is what we look at and if it helps the resident then we recommend the side rails. The Therapy Director said their role was to see if the siderail helps with mobility, we do not do alternate interventions, that is for nursing to do. Based on observation, staff and resident interviews, review of facility policy and procedure, and record review, the facility failed to ensure 3 (Residents #7, #32, and #41) of 24 residents reviewed for accidents were assessed for alternative interventions prior to the use of bed rails. The findings included: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 19 of 25 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 10/12/2023 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)

F 0700 Level of Harm - Minimal harm or potential for actual harm The facility policy, N-1282, Side Rail/Bed Rail, effective 4/19/2018 documented The center will attempt alternative interventions, and document in the medical record, prior to the use of side rail/bed rail. 1. Record review revealed Resident #7 was admitted to the facility on [DATE]. Diagnoses included Chronic pain, Hypertension, Dementia. Residents Affected - Some The Care plan for Resident #7 was revised on 1/24/23 and included 1/4 bilateral side rails to promote independence in bed mobility. On 10/9/23 at 10:10 a.m., Resident #7 was observed in bed with 1/4 side rails in the up position. On 10/10/23 at 10:16 a.m., Resident #7 was observed in bed with 1/4 side rails in the raised position on both sides of the bed. Resident #7 said she did not request the rails but did use them to move in bed. Review of Resident #7's clinical record showed a Consent for Use of Siderails dated 2/22/20 and signed by the resident. The record showed a side rail assessment dated [DATE], documented side rails or assist bar was recommended and alternatives to side rails were discussed with the resident. The form did not document the alternatives that were attempted or documentation of why the alternative interventions were not adequate to meet the resident's needs. 2. On 10/09/23 at 10:01 a.m.,10/10/23 at 2:50 p.m., and 10/11/23 at 8:34 a.m., Resident #32 was observed in bed with 1/4 side rails in the raised position on both sides of the bed. Record review revealed Resident #32 was admitted to the facility on [DATE]. Diagnoses included Dementia, and muscle weakness. A review of Resident #32's clinical record showed a Physician order dated 11/7/22 for 1/4 Bilateral Side Rails while in bed. A Consent for use of Bed Rails was signed by the resident and dated 11/11/22. The record showed a side rail assessment dated [DATE], documented side rails or assist bar was recommended and alternatives to side rails were discussed with the resident. The form did not document the alternatives that were attempted or documentation of why the alternative interventions were not adequate to meet the resident's needs. On 10/12/23 at 9:39 a.m., the Director of Nursing (DON) stated prior to implementing any side rails, documentation of attempting interventions prior to side rail use must be documented. Once documentation of the intervention is done, the resident will be assessed after the side rails are placed to ensure they are effective for that resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 20 of 25 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 10/12/2023 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)

F 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on staff interviews and staff record reviews, the facility failed to ensure 3 (Staff G, J, and K) of 5 Certified Nursing Assistants records reviewed had a performance review completed at least once every 12 months as required. Residents Affected - Few The findings included: On 10/12/23, a review of Certified Nursing Assistant (CNA) Staff G's employee file revealed a hire date of 11/28/18. There was no documentation Staff G had an employee performance/competency review in 2022 or 2023. On 10/12/23, a review of Certified Nursing Assistant (CNA) Staff J's employee file revealed a hire date of 10/28/21. There was no documentation Staff H had an employee performance/competency review in 2022 or 2023. On 10/12/23, a review of Certified Nursing Assistant (CNA) Staff K's employee file revealed a hire date of 10/7/20. There was no documentation Staff H had an employee performance/competency review in 2022 or 2023. On 10/12/23 at 11:57 a.m., the Human Resource Director Staff Z confirmed there was no documentation a performance review was completed for Staff G, Staff J, and Staff K. Staff Z said we were not aware the annual performance review was not completed as required but going forward we have a plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 21 of 25 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 10/12/2023 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)

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. On 10/9/23 at 9:28 a.m., in an interview Resident #57 said she was allergic to pork and the kitchen is still sending it. She said she was allergic to Styrofoam and had asked not to receive her meals in Styrofoam but they keep sending it. Resident #57 said, I tell them every day, but they keep sending pork. Today I had bacon with my eggs. Observation of the noon meal on 10/9/23 at 12:52 p.m., Resident #57 received the savory pork roast as indicated on the meal ticket and did not eat any portion of the meal. The resident said I keep telling them I don't eat pork. I told the certified nursing assistant (CNA) when he brought me the lunch tray, I don't eat pork. He said well then, it's chicken and walked out of the room. I know the difference between pork and chicken, I'm not stupid. Review of the lunch meal ticket identified allergies Shellfish allergy, Styrofoam allergy. The meals ticket listed savory pork roast, as the main entrée for the noon meal on 10/9/23. On 10/9/23 at 1:30 p.m., CNA Staff E was observed telling Resident #57 she went to the kitchen to tell the staff the resident did not eat pork and they are making her a burger. Resident #57 said that sounds wonderful. Review of the electronic record and the hard paper chart showed no dietary preference form was completed for Resident #57. On 10/10/23 at 9:10 a.m., Resident #57 said someone from dietary came today and spoke with her about what she liked and did not like. I told them I don't eat pork because of my religion, I'm Jewish and I don't eat pork. On 10/11/23 at 8:48 a.m., in an interview the Dietary Manager Staff F confirmed she was not able to locate the food preference form for Resident #57. Staff F said the process is upon admission a dietary member goes to meet the resident and obtain any allergies, likes/dislikes and they are entered into the electronic record. The meal tracker system prints the information on the residents meal ticket. I know Resident #57 does not eat pork, I found out on 10/9/23. The CNA came and told me the resident refused to eat the pork roast and I made her a burger. On 10/11/23 at 1:06 p.m., Staff F provided a food preference interview dated 9/20/23 and signed by the Regional Director and dated 10/11/23. The preferences did not list no pork in the dislike section. On 10/11/23 at 3:09 p.m., Staff F confirmed Resident #57's meal ticket was not updated with her food and religious preferences. Based on observation, review of the policies and procedures, resident and staff interview, the facility failed to obtain food preferences and provide meals according to resident's religious and personal choices for 8 (Resident #1, #2, #4, #7, #32, #57, #59, #67) of 20 resident who complained about not having food choices. The findings included: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 22 of 25 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 10/12/2023 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)

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The facility policy Dining and Food Preferences dated 5/20/14 documented, Individual dining food and beverage preferences are identified for all residents/patients. The Dining Services Director or designee will interview the resident or resident representative to complete a food preference interview within 48 hours of admission. The purpose of identifying individual preferences for dining location, mealtimes, including times outside of the routine schedule food and beverage preferences. The food preference interview will be entered into the medical record. Food allergies, food intolerance, food dislikes and food and fluid preferences will be entered into the resident profile in the menu management software system. The individual tray assembly ticket will identify all food items appropriate for the resident based on diet order allergies and intolerance's and preferences. The dining and food preferences procedure stated, a food preference interview will be completed within 48 hours of admission The food preference interview will be entered into the medical record .The individual tray assembly ticket will identify all food items appropriate for the resident based on diet order, allergies & intolerances, and preferences. Upon meal service, any resident with expressed or observed refusal of food will be offered an alternate selection of comparable nutrition value. Resident council meeting minutes noted several food complaints consisting of residents not getting what they ask for. One resident stated she was on a special diet and was served things she should not eat. Another resident complained he has asked many times for quesadillas. listed on the always available menu and has never been able to get it. The food committee meeting minutes for 4/18/23, 5/16/23, 7/18/23, and 9/14/23 revealed resident concerns included running out of cold cereal, missing items on trays, gravy not available on mashed potatoes, alternatives which were not received, condiments not on tray, not getting the food they ask for and are told the kitchen has run out of an item. On 10/9/23 at 12:15 p.m., The dining room observation noted Resident #67 was missing mashed potatoes, (Photographic evidence obtained); Resident #67 said no one has asked him about his preferences. Resident #2 was missing corn bread, margarine identified on her tray ticket. Photographic evidence obtained. Resident #59 stated I asked for soup on the alternate menu, I can't eat any of the this. Resident #7 stated I live off Peanut Butter and Jelly, and boost that my brother sends me. The food is bad here. Too many pinto and lima beans, I'm sick of Swiss and Salisbury steak. No one has ever asked me about my preferences. On 10/10/23 the facility ran out of capri blend vegetables during tray line. On 10/11/23 at 12:23 p.m., Resident #1's meal ticket listed pureed peas, pureed dinner roll, pureed Carmel apple cake. There were no peas, the dinner roll and Carmel apple cake were regular consistency, not pureed. Photographic evidence obtained. On 10/11/23 at 3:28 p.m., the Registered Dietitian stated the Dietary Manager is supposed to meet with the resident to identify their preferences. She is new and is learning a lot, I'm trying to help (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 23 of 25 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 10/12/2023 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)

F 0806 with some of that. Level of Harm - Minimal harm or potential for actual harm On 10/11/23 at 3:48 p.m., Staff A, Certified Nursing Assistant (CNA), said sometimes the kitchen staff say they don't have stuff. Residents Affected - Some On 10/11/23 at 3:54 p.m., Staff P CNA stated if someone does not get the food they want or is missing items, which happens a lot, we go to the kitchen and ask if there are alternatives. On 10/12/23 at 9:36 a.m., the Director of Nursing stated the CNA will write on the clipboard posted by the menu what the resident wants to eat for meals for the day. She stated this should be done by each CNA for their residents. Photographic evidence obtained. On 10/12/23 at 10:04 a.m., CNA Staff R stated she has the 400 hall. Residents are not given choices for breakfast. Some of them I ask if they want what's on the menu or alternate. Most of the staff on the other side never ask the residents. On 10/12/23 at 10:05 a.m., Resident #4 said no one has asked or offered her any meal choices. On 10/12/23 at 10:07 a.m., Resident #32 stated no one has ever asked me what I want to eat. On 10/12/23 at 10:15 a.m., Resident #7 said no one has ever asked what I want to eat. On 10/12/23 at 11:24 a.m., the dietary manager stated The CNA is responsible for asking the resident what they want to eat and write it on the clipboard. The dietary manager stated she has been employed for 8 weeks and just started completing the dietary preference sheets today. On 10/12/23 at 11:27 a.m., the regional dietary manager stated the dietary preferences have not been documented and would be started today. On 10/12/23 at 12:41 p.m., the Regional Director of Clinical Services both verified there is not documentation of a preference assessment for the residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 24 of 25 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 10/12/2023 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 serve food in accordance with professional standards for food service safety. The failure to use beard coverings and perform hand hygiene could lead to cross contamination and cause food borne outbreaks. This had the potential to impact 93 residents consuming food at the community. The findings included: On 10/12/23 at 12:20 p.m., during a tour of the kitchen, dietary staff T and BB had beards and were not wearing beard coverings while assisting with tray line. Dietary Staff U was observed placing pizza slices and dinner rolls on lunch plates with his hands. Staff U was perspiring and wiped his forehead with his gloved hand, then wiped the gloved hand on his pants and continued to place pizza and rolls on the lunch plates without changing the gloves or completing hand hygiene. The Dietary Manager verified the observation and instructed staff U to discard the current plate. Staff U removed the roll from the plate he was instructed to discard, and put it on the next plate. Staff U did not change gloves or perform hand hygiene. On 10/12/23 at 12:27 p.m., the Dietary Manager and the Regional Food Service Director stated dietary staff T and BB should have been wearing beard coverings to prevent cross contamination into the food. The Dietary Manager stated staff U was educated on Tuesday and would be re-educated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105416 If continuation sheet Page 25 of 25