Inspection visit
Inspection
6 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 6 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0687
Provide appropriate foot care.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview, observation, and record review, the facility failed to provide toenail care, in a timely manner for 1
(Resident #67) of 1 resident reviewed for foot care.
Residents Affected - Few
The findings included:
Resident #67 was admitted to the facility on [DATE] with diagnosis in part to include:
End stage Renal Disease with dependence on renal dialysis, unspecified Protein Calorie Malnutrition, Atrial
Flutter, Bilateral Non Pressure Wounds of Lower Extremities, Anemia, Hypertension, Major Depressive
Disorder and difficulty in walking.
On 03/07/24 Resident #67 had an MDS (Minimum Data Set) assessment. The resident had a BIMS (Brief
Interview for Mental Status) of 15, which indicates the resident is cognitively intact. The assessment also
indicated the resident needed assistance with bathing, dressing and putting on and taking off footwear.
On 05/28/24 at 1:50 PM, an interview was conducted with Resident #67. The resident was sitting outside in
a wheelchair. He was wearing sandals. His toenails were observed. His right and left foot toenails were
long. On the left foot on the 2-digit the toenail was curving down into his foot. The resident stated they hurt,
and he stated he has told the nursing staff he wants them clipped. Photo evidence obtained with consent
from Resident #67. He stated he wears sandals because his toenails hurt too much to put shoes on his
feet.
The orders were reviewed. When the resident arrived on 12/21/23 an order was written for Podiatry, as
needed.
On 05/29/24 at 7:58 AM, an interview was conducted with the MDS Coordinator. She was asked about
Resident #67's toenails and why they had not been cut/trimmed. She stated they were working on it through
the VA. In review of the record an order was written on 05/28/24 at 6:30 PM for podiatry consult for ingrown
toenails after surveyor interview of Resident #67 on 05/28/24 at 1:50 PM.
On 05/30/24 at 12:16 PM the MDS Coordinator was asked who is responsible for the residents getting their
toenails cut/trimmed. She stated it is up to the nursing staff. She stated she thinks Resident #67 had
previously been on a list for podiatry care at the facility. She stated she was looking for the documentation.
On 05/30/24 at 12:18 PM Resident #67 was interviewed. He stated he has never had his toenails
(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 8
Event ID:
105558
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
105558
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/31/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at West Palm Beach
5065 Wallis Road
West Palm Beach, FL 33415
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 0687
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
cut/trimmed since he arrived at the facility, and they had not been cut or trimmed anywhere else which
includes the VA. He stated he has been asking the nurses and CNAs to cut/trim his toenails for the last 2
months.
On 05/31/24 at 7:40 AM Staff E, a CNA (Certified Nursing Assistant) was interviewed. She was asked
about residents and cutting/trimming fingernails and toenails. She stated she can cut the nails unless they
are diabetic or have another problem. Then she would notify the nurse.
On 05/31/24 at 7:50 AM Staff F, a CNA was interviewed. She stated if a resident needed their nails
cut/trimmed and if she was unable to cut them, she would notify the resident's nurse.
On 05/31/24 at 10:10 AM, an interview was conducted with Staff G, an LPN (licensed Practical Nurse). She
stated if a resident needs to have a podiatry consult for nailcare then she can get a consult for the resident.
In review of Resident #67's plan of care, he was assessed for an ADL (Activity of Daily Living) selfcare
deficit. The intervention dated 01/01/24 was for showering/bathing and documents to check nail length and
trim and clean on bath day as necessary. Report any changes to the nurse.
During the survey, no documentation was located to indicate Resident #67 had a previous consult for nail
care.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105558
If continuation sheet
Page 2 of 8
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
105558
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/31/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at West Palm Beach
5065 Wallis Road
West Palm Beach, FL 33415
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 0688
Level of Harm - Minimal harm
or potential for actual harm
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM
and/or mobility, unless a decline is for a medical reason.
Based on observation, interviews and record review, the facility failed to assess and provide Range of
Motion (ROM) as requested by the resident for 1 of 1 resident reviewed for ROM (Resident #53).
Residents Affected - Few
The findings included:
Resident #53 was admitted to the facility originally on 08/24/22. Diagnoses included Guillain-Barre
Syndrome, Type 2 Diabetes, Osteoarthritis, and Paraplegia. Her Brief Interview for Mental Status (BIMS)
score was 15 on the quarterly Minimum Data Set (MDS) with an assessment reference date of 04/26/24.
Section O of the MDS revealed she has not received Physical therapy (PT), Occupational therapy (OT) or
ROM in the last 7 days. Section GG of the MDS revealed her functional abilities was limitation in ROM on
both sides.
On 05/28/24 at 1:25 PM, an interview was conducted with Resident #53. She stated she was in the facility
because she never recovered from Guillain-Barre. Guillain-Barre causes your immune system to attack
your nerves, leading to symptoms such as weakness, tingling, numbness, and paralysis. She stated she
feels like if she does not have ROM she will get weaker.
A review of the resident's Physician orders revealed an order for Physical therapy evaluate and treat dated
08/10/23. A review of the resident's care plan with a focus of Acute/Chronic pain has an intervention of
Rehab services date initiated 09/05/22 and revision on 11/06/23.
On 05/31/24 at 9:28 AM, an interview was conducted with the Director of Rehabilitation (DOR). She was
asked if the Certified Nursing Assistant (CNAs) perform ROM during personal care. She stated that they
have a restorative aide who does ROM. The DOR stated that Resident #53's desire for ROM has not been
brought to her attention but she will do a screening today. She has no past record of her having
rehabilitation because previous therapies were with the previous company.
An additional interview was conducted with Resident #53 on 05/31/24 at 11:05 AM. She was asked if she
told any staff member that she would like additional ROM. She stated she told the MDS Coordinator in the
different meetings she has had with her. She also stated when her family was in town that she told her that
she would like to have more rehab or at least a screening so she can go home.
Interview conducted with the MDS Coordinator on 05/31/24 at 11:15 AM. The MDS Coordinator was asked
if she was aware that Resident #53 was asking for more rehab. She stated the resident refuses to get out of
bed, refuses medication and she is care planned for this. Asked if she has specifically refused a rehab
screening because that is not on the care plan and she stated she would have to look at her
documentation. The MDS Coordinator did not provide any additional documentation by the end of the
survey.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105558
If continuation sheet
Page 3 of 8
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
105558
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/31/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at West Palm Beach
5065 Wallis Road
West Palm Beach, FL 33415
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 0694
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, record and policy review, the facility failed to maintain a PICC (Peripherally inserted
central catheter) line in a sanitary manner for 1 of 1 resident sampled for PICC lines (Resident #375).
Residents Affected - Few
The findings included:
The facility's policy titled, Catheter Insertion Care effective 1/17/2019 revealed Change midline catheter
dressing 24 hour after catheter insertion, every 5-7 days, or if it is wet, dirty, not intact, or compromised in
any way.
Resident # 375 was admitted to the facility on [DATE] with diagnoses that included Acute Osteomyelitis of
the left ankle and foot, Pressure Ulcer of the left heel and Methicillin Resistant Staphylococcus Aureus
Infection as the cause of diseases classified elsewhere. A Brief Interview for Mental Status (BIMS) was
done on 05/13/24 and the resident scored a 15, which indicated he was cognitively intact.
On 05/28/24 at 11:00 AM, Resident #375 was interviewed and a PICC line was observed on the resident's
left upper arm. The dressing was covered with a tubular wrap. The resident was asked if the surveyor could
look at the dressing under the wrap and he agreed. The dressing was dated 05/09/24 which was the day
prior to the admission of the resident to the facility. The resident was asked if anyone had changed his
dressing since he was admitted to this facility and he stated that they flush it but had not changed the
dressing.
Review of the Physician orders for Resident #375 revealed an order to change dressing on admission or 24
hours after insertion and weekly thereafter and PRN (as needed) every night shift every Fri change
dressing weekly.
Review of the Medication Administration Record (MAR) for Resident #375 revealed three days the dressing
was initialed by a nurse as being changed on 05/10, 05/17 and 05/24.
On 05/29/24 at 1:55 PM, an interview was conducted with the Director of Nursing (DON). The DON stated
the PICC line dressing for Resident #375 was changed yesterday. Discussed that the PICC line dressing
was dated 05/09/24 yesterday. The DON was shown the MAR that showed nurses marked the dressing as
changed three times. The DON acknowledged that the dressing change was not done on those dates and
he will be doing in-services for the nurses.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105558
If continuation sheet
Page 4 of 8
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
105558
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/31/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at West Palm Beach
5065 Wallis Road
West Palm Beach, FL 33415
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
observations, interviews and record reviews, the facility failed to adhere to fluid restrictions for 1 of 2
residents reviewed for dialysis (Resident #37).
Residents Affected - Few
The findings included:
Resident #37 was initially admitted to the facility on [DATE].
According to the resident's most recent full assessment, an Annual Minimum Data Set (MDS), date
03/23/24, Resident #37 had a Brief Interview for Mental Status score of 11, indicating that Resident #37
was moderately cognitively impaired and that the resident required setup help only for eating. Resident
#37's diagnoses at the time of the assessment included: Anemia, Diabetes, Heart Failure, Hyperkalemia,
Peripheral Vascular Disease, Thyroid disorder, Anxiety Disorder, Depression, Chronic Lung Disease,
Disorders of Calcium Metabolism, Gangrene, Insomnia, Extrapyramidal and Movement Disorder, Long term
use of insulin, Dysthymic Disorder.
Resident #37's care plan for nutrition, initiated on 05/27/20 and most recently revised on 04/17/24,
documented, The resident has nutritional problem or potential nutritional problem increased nutrient needs
related to history of poor diet compliance, as evidenced by End Stage Renal Disease (ESRD) on
Hemodialysis (HD), and needs for therapeutic diet. - increased risk for fluid imbalances/weight fluctuations
due to HD treatment. 10/23/23: 1000 ml a day fluid restrictions - increased risk for altered hydration status.
The goal of the care plan was documented as, Will maintain adequate nutritional status as evidenced by
maintaining weight no signs/symptoms of malnutrition and consuming at least 76% of at least 2 meals daily
through review date. 05/27/20 with a revision date of 04/11/24 and a target date of 06/29/24.
Interventions included:
*Fluid restrictions per HD MD clinic1000 ml/day - 720 ml for dietary (240 ml per meal) 280 ml for nursing
staff (180 ml/6 oz 7 AM to 7 PM) 100 ml for 7 PM - 7 AM this exclude any supplements
Resident #37's care plan for Rejection of Care, initiated on 12/11/20 with a revision date of 04/02/24,
documented, Non-compliant with Dialysis fluid restrictions - independent with taking of fluids .May demand
that staff provide her with foods/fluids that are not recommended. Aware of the benefit - stability of medical
conditions. Family aware.
The goal of the care plan was documented as, Medical needs may not be adversely affected by her
non-compliance. 12/11/20 with a revision date of 04/11/24 and a target date of 06/29/24.
interventions to the care plan included:
* Allow the resident to make decisions about treatment regime, to provide sense of control.
* Educate resident/resident's representative/ caregivers of the possible outcome(s) of not complying with
treatment of care.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105558
If continuation sheet
Page 5 of 8
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
105558
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/31/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at West Palm Beach
5065 Wallis Road
West Palm Beach, FL 33415
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
Resident #37's care plan for Mood and Behavior, 08/07/22 with a revision date of 04/02/24, Resident is
alert: frequently request/demand food and fluids not recommended for her due to ESRD - dialysis
dependent/fluid restrictions. She is not easily redirected, dismissive, and may be verbally and or physically
disruptive - swearing .Refusing to comply with dietary restrictions/Fluid restrictions.
Residents Affected - Few
interventions included:
* Document/report behavior attempt to determine underlying cause.
Resident #37's care plan for dialysis, initated 05/27/20 with a revision date of 05/07/24, documented,
Dialysis: Hemodialysis secondary to ESRD on Monday, Wednesday, Friday at Dialysis center
The goal of the care plan was documented as, will have no signs/symptoms of complications from dialysis
05/27/24 with a revision date of 04/11/24 and at target date of 06/29/24.
Interventions included:
*Fluid restriction. See POS/MAR
Resident #37's orders included:
Hemodialysis secondary to ESRD on Monday, Wednesday, Friday at Dialysis center. Chair time at 9:15 AM.
Pick up time: 8:00-8:30 AM. Estimated return time 1:45 PM - 3:00 PM. Transportation with VCT - 03/30/24.
CCD Renal diet Regular texture, Regular/thin Liquids consistency - all meats fortified: Tuna sandwich and
applesauce @ HS. 1000 ml day Fluid restrictions per HD MD. 720 ML Total/Day: 8 oz coffee @ B 8 oz apple
juice at L/D Nursing 280 ml Total/Day 7 AM-7 PM: 180ml/6ox 7 PM-7 AM: 100 ml for Hemodialysis related
to End Stage Renal Disease - 03/15/24.
On 05/28/24 at 12:46 PM, Resident #37 was noted with a 16 ounce Styrofoam cup of water on the over bed
table.
On 05/29/24 at 7:30 AM, Resident #37 was observed in bed with breakfast in bed. Resident #37 was noted
to have a cup with approximately 4 ounces of apple juice and a cup with approximately 6 ounces of coffee
and a 16 ounce Styrofoam cup of water on the overbed table. Resident appeared to be confused and not
interviewable at the time of the observation and was not able to demonstrate knowledge or understanding
of fluid restrictions.
On 05/29/24 at 7:35 AM, the MDS Coordinator stated that 11-7 staff responsible for the water at 6 AM and
that staff on the 7-3 shift would be passing water again prior to the lunch meal.
On 05/31/24 at 6:38 AM, Resident #37 was observed sitting on right side of the bed. The resident was
noted to have a cup with approximately 4 oz of clear fluid, a cup with approximately 4 oz of apple juice and
a cup with approximately 8 oz of hot tea on over bed table. At the time of the observation, Resident #37
appeared confused and was not able to demonstrate knowledge or understanding of fluid restrictions.
During an interview, on 05/31/24 at 7:01 AM, with Staff C, LPN, when asked about the fluids
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105558
If continuation sheet
Page 6 of 8
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
105558
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/31/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at West Palm Beach
5065 Wallis Road
West Palm Beach, FL 33415
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
provided to Resident #37, Staff C replied, every time when someone passes by, she will ask for something
to eat and something to drink. After she is done and we try to take it away, she will get angry so we leave it
for her.
During an interview, on 05/31/24 at 7:06 AM, with the Director of Nursing (DON), when asked about the
fluids provided to Resident #37, the DON replied, her fluid came from kitchen, the only time the nurses give
fluid is during medications. The dietitian determines the fluid restrictions and how much fluids she can have.
She is sneaky, she will go to the vending machine as well and we have to keep telling her that she can't
have it. Asked about resident being aware of fluid restrictions, we educate her.
On 05/31/24 at 7:20 AM, Staff D, CNA, was observed serving a tray to Resident #37's room for breakfast. It
was noted that the resident was being served approximately 4 ounces of apple juice and 6 ounces of
coffee, while there was already 4 oz of clear fluid, a cup with approximately 4 oz of apple juice and a cup
with approximately 8 oz of hot tea on over bed table. During an interview with Staff D at the time of the
observation, when asked about the fluids provided to Resident #37, Staff D replied, that was from 3-11
(referring to the fluids that were already in the room prior to breakfast being served). She is very difficult.
When we take her fluids away, she will go to the kitchen and ask for fluids and the Director says that she is
alert and oriented, so he gives them.
On 05/31/24 at 7:34 AM, the District Manager from the contract company overseeing the kitchen reported
to this Surveyor, the CNA came and asked for apple juice, and we gave it to her and we didn't know that it
was for the resident (referring to Resident #37).
On 05/31/24 at 8:22 AM, Resident appeared to be confused during attempted interview and was unable to
demonstrate knowledge of fluid restrictions.
During an interview, on 05/31/24 at 9:20 AM, with the Registered Dietitian, when asked about the risks
associated with no adhering to the fluid restrictions, the Registered Dietitian replied, fluid overload - she
can get worse and cause cardiac arrest due to the fluid overload. Her edema can be exasperated. The main
issues is cardiac issues. In the past, she was more oriented and able to understand.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105558
If continuation sheet
Page 7 of 8
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
105558
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/31/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at West Palm Beach
5065 Wallis Road
West Palm Beach, FL 33415
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
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observations, interviews and record reviews, the facility failed to provide foods prepared under
sanitary conditions and in accordance with standards for food safety professionals.
Residents Affected - Some
The findings included:
1). During the initial kitchen tour, on 05/28/24 at 8:48 AM, accompanied by the District Manager for Health
Services Group (contracted to oversee the kitchen/dietary ) the following were noted:
a. An employee's personal cellular device on prep table by the walk in cooler.
b. There was an accumulation of food residue on the sharpening stones to slicer.
c. A 1/3 sized six inch deep container of barbecued pork in the process of cooling from the previous day
was 49 degrees Fahrenheit (F). The District Manager confirmed that the pork was in the process of cooling
from being served the day before.
d. A 1/3 sized six inch deep container of meatballs in the process of cooling from the previous day was 51
degrees F. The District Manager confirmed that the meatballs were in the process of cooling from being
served the day before.
e. In the food services area, the wall to the left of the hand washing sink was damaged.
f. In the food services area, there was an accumulation of black residue inside of the ice machine.
2). During the follow up tour of the kitchen, on 05/30/24 at 11:01 AM, accompanied by the District Manager
and the Account Manager, the following were noted:
a. Staff A, Dietary Aide, was observed adjusting glasses that Staff A was wearing. Staff A then proceeded
to another area of the food service area to answer a phone call on her personal cellular device, and then
placed the cellular device into her back pocket before opening and closing the reach in cooler. As Staff A
began retrieving trays through a window from the kitchen to the food service area, this Surveyor intervened
and instructed Staff A to perform hand hygiene at the hand washing sink. Staff A and the District Manager
acknowledged that Staff A had not performed hand hygiene at any time that the observation was being
made.
b. There was ice from an unknown source in the only hand washing sink in the food service area.
c. Staff B, Dietary Aide, was noted to be wearing loose fitting bracelets while preparing to receive trays from
the kitchen to the food services area.
d. Staff A was observed handling portioned drinks with bare hands in direct contact with the lip contact
surface of the cups.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105558
If continuation sheet
Page 8 of 8
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Back to topCitations
6 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F687 - Foot care
Provide appropriate foot care.
F688 - Mobility
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
F694 - Parenteral Fluids
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
F698 - Dialysis
Provide safe, appropriate dialysis care/services for a resident who requires such services.
- 0355GeneralS&S Dpotential for harm
Properly select, install, inspect, or maintain portable fire extinguishes.
FAQ · About this visit
Common questions about this visit
What happened during the May 31, 2024 survey of AVIATA AT WEST PALM BEACH?
This was a inspection survey of AVIATA AT WEST PALM BEACH on May 31, 2024. The surveyor cited 6 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at AVIATA AT WEST PALM BEACH on May 31, 2024?
Yes, 6 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordanc..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.