Health inspection·February 23, 2023

F 0550 Statement: Procedure Provide privacy . Level of Harm - Minimal harm or potential for actual harm Review of facility Certified Nursing Assistant (CNA) job description on 02/23/23 at 10:30 AM created September 2018 provided by the DON documented Purpose of your Job Position: As a .(CNA), you are delegated that administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. The (CNA) works under the direction of licensed personnel to provide quality resident care in accordance with applicable regulations. Supervises none Duties and Responsibilities 5. Demonstrate understanding of and utilize proper infection control practices/policies .9. Maintain a clean, safe, and secure environment for residents. 10. Act in compliance with all corporate, state, federal, and other regulatory standards 15. Demonstrate respect and compassion in every interaction .45. Perform all other duties as assigned. Resident's Rights . Ensure that you treat all residents fairly, and with kindness, dignity, and respect . Residents Affected - Few Review of facility licensed nurse job description on 02/23/23 at 4:56 PM created September 2018 provided by the DON documented Purpose of your Job Position: As a .Clinical Nurse I-LPN, you are entrusted with the responsibility of caring for our residents, families, co-workers, visitors, and all others to provide direct nursing care to the residents, and to supervise the day-to-day nursing activities performed by nursing assistants .Job function: As a Clinical Nurse I-LPN, you are delegated that administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. Responsible for providing direct resident care in accordance with established plans. Supervises Nurse Techs .Duties and Responsibilities: 4. Conduct and document a thorough evaluation of each resident's medical status upon admission and throughout the resident's course of treatment 15. Conduct oneself with the highest degree of honesty and integrity in every interaction 20. Perform other duties, as assigned Resident's Rights Ensure that all nursing care is provided in privacy . 1) Resident #3 was re-admitted to the facility on [DATE] with diagnoses which included Diastolic Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Bipolar Disorder, Schizophrenia, Hypertension and Dementia. She had a Brief Interview Mental Status (BIMS) score deemed (severely impaired). During an observational room tour conducted on 02/20/23 at 10 AM, Resident #3's un-covered legs/lower body was visibly observed from the hallway into the front entry doorway to her room, with no privacy curtain covering the left side of her person. Upon further entry into the room, the resident was observed lying in her bed with no bed covers on and both of her legs and lower half of her person exposed revealing her diaper in place. Photographic evidence was obtained. During an interview conducted on 02/22/23 at 1:52 PM with Staff A, a CNA (Certified Nursing Assistant) she acknowledged that Resident #3's person was uncovered while lying in bed and visible from the doorway. However, she stated that the resident should have been covered. An interview was conducted on 02/22/23 at 1:58 PM consecutively with Staff C, a Licensed Practical Nurse (LPN), and with Staff D, an LPN/Unit Manager/(UM) in which both also acknowledged that Resident #3's person was uncovered while lying in bed and should have been covered. 2) Resident #10 was re-admitted to the facility on [DATE] with diagnoses which included Anemia, Gastrostomy Status, Hypertension and Major Depressive Disorder. She had a Brief Interview Mental Status (BIM) score of 12 (moderately impaired). On 02/20/23 at 11:32 AM during an observational tour, the DON (Director of Nursing) was observed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 2 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few seated at the Nursing Station, speaking with one (1) of the AHCA (Agency for Healthcare Administation) surveyors who was inquiring about the room location of Resident #10. The DON loudly and without hesitation, referred to this resident as a Tube Feeder, right in front of two (2) AHCA surveyors, while she was standing in the Nurses' Station. Subsequently, on 02/20/23 at 11:35 AM, the DON was then asked for confirmation of what she had just said regarding the Resident #10's dietary status, and she again repeated that the resident was a Tube Feeder, without even realizing what she had just said out loud to the two (2) AHCA surveyors. 3) During a lunch meal observation conducted on 02/20/23 at 1:05 PM, Resident #3's lunch tray was observed still sitting on the meal cart, un-touched. Resident #3 was assigned to Staff E, a CNA and she was asked by one (1) of the AHCA surveyors as to why this resident's tray was still there and not being served to the resident, in a timely manner. And, Staff E told the surveyors that because she had to first feed another (Resident #11). Then she said that she could assist in feeding Resident #3. Photographic evidence was obtained. On 02/20/23 at 1:08 PM Staff D was then observed by two (2) AHCA surveyors, just walking by the lunch meal cart containing Resident #3's lunch tray. However, there was no observation of any attempt made by her, to pick up the resident's lunch meal tray and take it into her room to assist her, at that time. On 02/20/23 at 1:12 PM, an interview was conducted with Staff D, in which she was asked why she had been observed previously by two (2) AHCA surveyors as having only walked back and glanced at Resident #3's lunch meal tray (which still remained in the cart), instead of taking the tray down to the resident's room to assist her to eat, in a timely manner. Staff D, replied to this Surveyor, this is what the CNAs are to do, and she just walked away. On 02/20/23 at 1:20 PM Resident #3 was now observed finally being assisted with her lunch meal by Staff E; more than fifteen (15) minutes later after her other three (3) roommates had already consumed/were assisted with their lunch meals. 4) During an observational room tour conducted on 02/22/23 at 9:49 AM, Resident # 36's Foley catheter bag was observed from the hallway, located on the floor next to his bed, without a privacy bag in place covering it. During an interview conducted on 02/22/23 at 1:50 PM with Staff F, a CNA, caring for Resident # 36 in which she was asked about the current location/position of the resident's Foley catheter. She acknowledged that the resident's Foley catheter was located on the floor, and it was un-covered, when it should have been off the floor and covered with a privacy bag. An interview was conducted on 02/22/23 at 1:58 PM consecutively with Staff C, and with Staff D in which both also acknowledged that Resident #36's Foley catheter was located on the floor, and it was un-covered, when it should have been off the floor and covered with a privacy bag. The DON further recognized and acknowledged that on 02/22/23 at 2:10 PM, that all residents must always be treated and referred to in a dignified and respectful manner, at all times; this was not done. 5) In an observation conducted on 02/22/23 at 5:51 PM, the dinner trays arrived at room [ROOM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 3 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few NUMBER]'s, and the dinner trays were given to the following residents: Resident in bed 100 D, bed 100, and Resident in bed 100 B. Resident #23 (in a different room) did not get her dinner tray then. Continued observation showed that Staff brought the dinner tray to Resident #23 at 6:14 PM, 23 minutes later. Residents in bed 100 D and bed 100 were already done with their dinner trays. A record review showed that Resident #23 was readmitted on [DATE], and the Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 99, which is cognitively impaired. Section G for eating showed that Resident #23 needed extensive assistance. Diagnoses of Dysphagia and Anorexia were noted as well. 6) In an observation conducted on 02/22/23 at 6:13 PM, the dinner tray arrived at room [ROOM NUMBER] and was given to the Resident in bed 115 B. Resident #7 (in a different room) did not get her dinner tray then, and the roommate in 115 B said, the dinner tray did not come for Resident in 100 A bed. Continued observation showed that Resident #7 received her dinner tray from Staff at 6:27 PM, 14 minutes later. A record review showed that Resident #7 was admitted on [DATE], and the Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 7, which is cognitively impaired. Section G for eating showed that Resident #7 is dependent on Staff for eating. An interview conducted on 02/23/23 at 4:10 PM with Staff B, Certified Nursing Assistance (CNA), stated that she was educated by the facility on dignity. She was to knock when you entered the rooms and pull drapes around during baths and showers when assisting residents with their daily needs. It is important to sit at an eye level and clean any residents who soil themselves or drool. Staff B also stated that when you pass the trays in the rooms, it is important to ensure everyone is eating simultaneously. She did say that for some of the residents who need assistance with dining, their trays are left on the meal cart in the hallway until she is ready to come into their rooms and assist with the meals. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 4 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to maintain the hot water temperature at an acceptable level for the safety of the residents observed during an Environmental tour for 7 rooms out of 20 rooms occupied. The findings included: The policy titled, Monitoring and Recording Facility Hot Water Temperatures for Residents' Rooms, Common Areas, and Shower Rooms, dated 11/30/2014, showed to maintain and control hot water temperatures within the facility to federal and state standards. Hot water temperatures will be maintained at an acceptable level for the safety of the residents and staff. The following procedures will be implemented, by the Maintenance staff, if a hot water temperature is found to be above 110 degrees Fahrenheit, the acceptable level for resident rooms, showers, and common areas: (If high temperature is found on the weekend or holidays, immediately call the maintenance staff). In a tour conducted on 02/22/23 from 10:44 AM to 12:00 PM, the following rooms were visited accompanied by the facility's Maintenance Director. The hot water temperatures were checked in the bathroom's sinks using the facility's own thermometer: In room [ROOM NUMBER], hot water in the sink was recorded at 120 degrees Fahrenheit; in room [ROOM NUMBER], water in the sink was recorded at 120 degrees Fahrenheit, room [ROOM NUMBER], water in the sink was recorded at 122 degrees Fahrenheit, room [ROOM NUMBER], water in the sink was recorded at 124 degrees Fahrenheit, room [ROOM NUMBER], water in the sink was recorded at 125 degrees Fahrenheit, room [ROOM NUMBER] water in the sink was recorded at 120 degrees Fahrenheit, and room [ROOM NUMBER] water in the sink was recorded at 124 degrees Fahrenheit. The issue affected seven rooms with a total of 11 residents. During this tour, the Maintenance Director stated that he did not know that the hot water in these rooms was above 110 degrees Fahrenheit. He further revealed that two water heaters are located outside the facility, connected to these rooms, and control the hot water in the above rooms. He changed the elements in one of the hot water heaters on the right when he noticed that the older elements were rusty and old and needed changing. When asked when he changed the elements in the water heater, he said a week ago. He also reported that the water temperature in the water heater tanks could only be adjusted inside the water heaters, and one needs to open the water heaters from the inside to adjust the temperatures. When asked how he regulates the temperatures, he stated that it is hard for a person to control the temperature. The Maintenance Director further said that he conducts room audits and visits regularly to check the hot water in the chosen rooms. He said that he only picks a few rooms at a time to complete his audits. Record review showed that the above seven rooms with hot water above 120 degrees Fahrenheit had 11 residents altogether. All eleven residents were reviewed for the Brief Interview of Mental Status (BIMS) score for their cognitive abilities. All 11 residents were also reviewed for their mobility under section G of the Minimum Data Set. Two residents out of the 11 residents had BIMS scores below ten which showed that they had a cognitive deficit and were somewhat confused. These two residents could also walk around and use the bathrooms when needed. In an interview conducted on 02/22/23 at 3:30 PM, the Maintenance Director stated that he emptied both water heaters connected to the aforementioned rooms and said that he lowered the water gauge temperature inside the heat. This was done after Surveyor interventions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 5 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interviews, the facility failed to provide wound care consistent with professional standards of practice to prevent infection and to follow physician's order for wound care for 1 of 1 sampled residents reviewed for pressure ulcers (Resident #6). Residents Affected - Few The findings included: Review of the facility's policy titled Dressing Change revised on 12/06/17 and policy titled Skin and Wound revised on 01/24/22 revealed the policy did not address wound care technique. Review of Resident #6's clinical record documented an initial admission to the facility on [DATE] with no readmissions. The resident's diagnoses included Diabetes Mellitus, Cognitive Communication Deficit, Anemia, and Alzheimer's. Review of Resident #6's Minimum Data Set (MDS) annual assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 8, indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed supervision to limited assistance with his activities of daily living (ADL). The assessment documented that the resident did not have a pressure ulcer during the assessment period. Review of Resident #6's care plan titled Resident #6 has a potential for ADL self-care performance deficit related to Dementia. Currently he is able to perform ADLs with supervision/assistance for safety. The care plan was initiated on 10/12/18 and revised on 07/14/20. Care plan interventions included resident requires skin inspection initiated on 06/01/20. Review of Resident #6's physician order dated 02/10/23 documented Cleanse left buttock with wound cleanser, apply Mupirocin 2% ointment to site, cover with foam dressing and change daily and as needed every day shift for wound care. On 02/22/23 at 8:32 AM, observation revealed Resident #6 in his room sitting in a wheelchair and eating breakfast. During an interview, the resident agreed with wound care observation. On 02/22/23 at 9:34 AM, observation of wound care for Resident #6 performed by Staff G, Licensed Practical Nurse (LPN) was conducted. Staff G retrieved the following wound care supplies: four (4) normal saline vials, alcohol pads, Mupirocin 2 % ointment tube, one red bag, one bordered gauze and two 4 x 4 gauze packages from the treatment cart. Staff G entered Resident #6's room with the wound care supplies and placed the supplies on top of the sanitized table. Staff G performed hand hygiene, donned gloves and proceeded to open the gauze packaging, the bordered dressing packaging, pulled a pair of scissors from her pocket and placed on top of the table without disinfecting it. Staff G, LPN removed gloves, performed hand hygiene and poured Mupirocin ointment into a medication cup. Staff G removed her gloves, performed hand hygiene, donned gloves and then soaked the 4 x 4 gauze with normal saline. Observation revealed Staff G cleaned Resident #6's left buttock wound with one normal saline soaked gauze from the wound bed (inside the wound) to the outside/surrounding area of the wound. Staff G made back and forth strokes from the surrounding area of the wound and back to the inside of wound opening with the same gauze. Staff G retrieved a dry gauze, dry pat the wound bed and the surrounding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 6 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0686 area. Level of Harm - Minimal harm or potential for actual harm Observation revealed Staff G removed her gloves, performed hand hygiene and donned gloves. Further observation revealed Staff G with her gloved index finger swept the Mupirocin ointment and with her finger, applied the ointment in to the resident's wound. Residents Affected - Few Furthermore, observation revealed Staff G applied Mupirocin ointment in a back and forth strokes movement from the wound bed to the wound perimeter and back to the wound bed. Subsequently, an interview was conducted with Staff G , who stated she should clean the wound from dirty to clean but was nervous. Staff G was apprised that she when back and forth from dirty to clean, then clean to dirty with the same gauze. Staff G confirmed she used only one gauze to clean the wound and the perimeter. Staff G was apprised of using her finger to apply the Mupirocin ointment and that she applied the ointment on the wound bed and then on the surrounding and back to the wound. Staff G asked how else she can do it and added she thought she had to apply it to the surrounding area. Staff G was asked about the physician order and stated the physician order is to apply to the wound, not to the surrounding area. On 02/23/23 at 1:30 PM, during an interview, the facility's Director of Nursing (DON) was apprised of wound care observation findings. The DON stated Staff G should have wound cleanser as per physician order, not normal saline. The DON stated that Staff G should use one gauze to clean the wound from inside out and discard (from dirty to clean) and should not use her finger to apply the ointment to the wound. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 7 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record review, the facility failed to provide nutritional intervention and assessment in a timely manner for 1 of 3 sampled residents reviewed for nutrition (Resident #35). Residents Affected - Few The findings included: The facility's policy titled, Medical Nutrition Therapy Assessment and Care Planning, revised on 09/2017, showed that a Registered Dietitian is responsible for completing a comprehensive nutritional assessment to identify and plan the nutrition care based on the needs, goals, and preferences of each Resident. In an interview conducted on 02/23/23 at 2:20 PM, Resident #35 was observed in her bed resting. She stated that she had gained some weight, had a great appetite, and was always hungry. Resident #35 noted that the Clinical Dietitian has yet to speak to her to obtain food likes and preferences or any additional snacks between meals. She further said that she likes coffee/mocha flavor shakes and Boost but that the facility does not offer these flavors or options. A record review showed that Resident #35 was readmitted to the facility on [DATE] with Anemia, Muscle Weakness, and Cancer Diagnoses. Minimum Data Set (MDS) dated [DATE] showed that she had a Brief Interview of Mental Status (BIMS) score of 15, which is cognitively intact. A review of the Physician's orders showed the following: an order for a Regular texture diet with thin liquids and low fiber, which was dated 09/28/22. Colostomy care every shift as needed, which was dated 09/28/22. The further review did not show any orders for nutritional supplements, double portions, or fortified foods. The weight logs showed the following weights for Resident #35: 12/02/22 at 124 pounds, 01/20/22 at 102 pounds, 01/27/22 at 99 pounds, 02/10/23 at 106 pounds, and 02/17/23 at 109 pounds. Further record review revealed on 12/25/22, Resident #35 suffered a fall in the facility with a hematoma to the area and was transferred to the hospital 12/25/22. She was readmitted from the hospital on [DATE] with an Occipital fracture. A review of the Nutrition Evaluation that was conducted on 01/06/23, four days after Resident #35's admission, showed that the following: the weight of 124 pounds from her prior admission was used to assess her needs, and no new readmission weight was taken on 01/02/23. It showed that fortified food at breakfast and lunch was in place and that she had a good appetite of 75 to 100 percent intake. The recommendations were made to continue with fortified food at breakfast and lunch and to monitor the intake of meals and weight. A review of the Medication Administration Record (MAR) for the month of January 2023 did not show that Resident #35 had an order for fortified food or nutritional supplement in place. The next clinical progress note dated 01/20/23 (18 days after her readmission) showed a significant weight loss noted of 7.5 percent. It further showed that the weight loss was anticipated and that Resident #35 was eating 50 to 100 percent of her meals. This note showed that Resident #35 was receiving fortified foods for breakfast and lunch and a House Shake (nutritional supplements) twice a day. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 8 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The Clinical Dietitian recommended stopping the house shakes because the Resident did not like the flavor. She further recommended adding fortified food for dinner as well. A review of the MAR for the month of January 2023 and February 2023 did not show that Resident #35 was on any fortified foods or nutritional supplements. Another follow-up note completed on 01/27/23 showed that Resident #35 was underweight and had a good appetite with a 50 to 100 percent intake of meals. It further showed that Resident #35 was receiving fortified foods and recommended adding large portions due to a good intake of meals which was not added to the diet order. A progress note dated 02/10/23 showed that Resident #35 received fortified foods and many meals. The care plan dated 01/16/23 showed that Resident #35 had a nutritional problem related to cancer, significant weight changes, and chemotherapy. It further showed to monitor intake and make diet changes and recommendations as needed. A review of the CNA's Certified Nursing Assistants documentation of Resident #35's percent intake of meals in the last 30 days showed that she ate 76 to 100 percent of her meals on 02/21/23 and 02/22/23, but not on other days were documented. In an interview conducted on 02/23/23 at 5:15 PM with the Clinical Dietitian, she stated that she did not get an admission weight on Resident #35 and that she used her weight from prior admission. She also said the fortified meals were placed in the meal tracker but not on the diet orders. The Clinical Dietitian added the large portions to the meal tracker on 01/27/23 and did not provide Resident #35 with another nutritional supplement. When asked about providing Resident #35 with a different type of dietary supplement, she said that they only have one kind and that the kitchen will not make any homemade shakes because they do not have a mixer. When asked if she visited Resident #35 to obtain food likes and preferences, she said that it is not her responsibility but the Foods Service Director's. Surveyor stated that getting food preferences from residents is an essential part of the Clinical Dietitian, and she said, I am sure I visited her in the past. She was not able to show Surveyor any preferences that were recorded for Resident #35. In an observation conducted on 02/23/23 at 5:35 PM, Resident #35 was eating her dinner meal. A closer observation of the meal ticket showed large portions with fortified mashed potatoes. The dinner plate was noted with fortified mashed potatoes but no large portion and only three small pieces of chicken nuggets. In this Observation, Resident #35 said that she is sick of the fortified mashed potatoes every day and she is always starving. She asked Surveyor if she could get a large order of macaroni and cheese that was given to other residents for dinner. At 5:40 PM, the Food Service Director accompanied Surveyor to Resident #35's room. Resident #35 finished her all-dinner plate and said, I am starving, and the medication I take is making me eat so much she further told the Food Service Director that she was not getting enough food in the facility and that she had to go across the street at night to buy more food. After the Surveyor interventions, the Food Service Director proceeded to obtain food preferences and snacks that could be given to Resident #35. An interview conducted on 02/23/23 at 6:00 PM with the facility's Registered Dietitian, who stated she went to see Resident #35 and updated her menu and food preferences. She will provide Resident #35 with a night snack, an extra serving of carbohydrates per meal, and fortified pudding since Resident #35 likes the chocolate flavor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 9 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and record review, the facility failed to monitor and to follow the physician orders for Tube feeding for 1 of 1 sampled residents reviewed for Tube Feeding (Resident #21). The findings included: Review of the facility's policy titled, Enteral Feeding- Enteral Nutrition Pump revised on 11/12/18 documented Nurses administer enteral feeding when volume control is indicated and as ordered by physician Review of Resident #21's clinical record documented an initial admission to the facility on [DATE] with a latest readmission on [DATE] . The resident's diagnoses included Parkinson's, Chronic Kidney Disease, Heart Disease, Dementia, Pain, Muscle wasting, Displaced Mid-cervical fracture of left femur with closed fracture routine healing and Anemia. Review of Resident #21's Minimum Data Set (MDS) admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 11, indicating that the resident had moderate cognition impairment. The assessment documented under Functional Status that the resident was total dependent on the facility's staff for his activities of daily living including, feeding and administration of medication via a feeding tube. Review of Resident #21's physician order dated 01/27/23 documented, Jevity 1.5 at 65 millimeters (ml/hr.) per hour for 20 hours via PEG (feeding tube). On at 8:00 AM and off at 4:00 AM; tv (total volume) 1300 ml/daily. On 02/20/23 at 4:10 PM, a medication administration observation for Resident #21 performed by Staff D, Licensed Practical Nurse (LPN) was conducted. Observation revealed a 1500 cc (cubic center meter) Jevity 1.5 cal ( a tube feeding formula) bottle hanged at a pole next to the resident. The bottle was labeled with a date of 02/20/23 and timed 8:00 AM. Further observation revealed the bottle had 1500 cc formula left in the bottle to be infused. The tube feeding machine was turned off. During the medication administration observation, Staff D stated I have to connect him to the feeding. At the time of the observation the tube feeding volume infused should have been 520 cc. The bottle was full, 1500 cc were left in the bottle, no feeding formula had been infused at the time of the observation. On 02/20/23 at 4:35 PM, observation revealed Staff D connected Resident #21 to the Jevity 1.5 cal feeding bottle connected labeled 8:00 AM and had 1500 cc of formula to be infused. On 02/21/23 at 8:10 AM, observation revealed Resident #21 in bed, awake. An interview was conducted with the resident who stated he was not having vomiting, diarrhea or abdominal pain. The resident stated no problems with his feeding formula. Observation revealed Resident #21's tube feeding pump on running at 65 ml/hr. The Jevity 1.5 cal feeding formula bottle of 1500 cc was labeled with date of 02/21/23 and timed 8:00 AM. On 02/21/23 at 11:57 AM, observation revealed Resident #21's tube feeding pump on running at 65 ml/hr. The Jevity 1.5 cal feeding formula bottle of 1500 cc was labeled with date of 02/21/23 and timed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 10 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 8:00 AM. The bottle had 1500 cc left to be infused at the time of the observation. At the time of the observation the tube feeding volume infused should have been 260 cc. The bottle was full (1500 cc) were left in the bottle; no feeding formula had been infused at the time of the observation. On 02/21/23 at 12:33 PM, an interview was conducted with Staff D, LPN who stated she had not heard that Resident #21 had any vomiting, diarrhea or any issues with the tube feeding infusion. On 02/23/23 at 3:25 PM, an interview was conducted with Staff D, LPN who confirmed she gave Resident #21 medications via PEG tube on 02/20/23. Staff D stated she was not informed/aware of any issues with the resident feeding pump and stated she connected the resident back to the pump at 4:10 PM after medication administration. Staff D was informed that the machine was off prior to the medication administration at 4:10 PM on 02/20/23 and that the bottle of Jevity was full (1500 cc) were still on the bottle. Staff D stated that she did not know that the resident's tube feeding was not running. Staff D was asked how she make sure the resident gets his nutrition as ordered and stated that because the pump was not beeping, she did not find a reason for her to check the feeding pump. Staff D stated she could not tell if someone turned the pump off and added that she will find out. Staff D was asked to get back to the surveyor. A side by side review of a photographic evidence taken on 02/21/23 at 11:57 AM of Resident #21's tube feeding bottle dated 02/21/23 timed 8:00 AM was conducted with Staff D. Staff D confirmed that she hung the bottle of 1500 cc at 8:00 AM on 02/21/23. The photographic evidence showed that the resident's feeding bottle had 1500 ml to be infused at the time of the observation. Staff D was apprised that by 11:57 AM, almost 4 hours after the connection of the full bottle of Jevity, the resident should have 260 cc infused of the feeding formula and the bottle was full. Staff D stated she did not know what happened. Staff D was apprised that there was no monitoring of the resident's feeding infusion. At the end of the survey, Staff D, LPN did not provide the surveyor with more information as requested related to Resident #21's pump and why it was turned off. On 02/23/23 at 4:56 PM, an interview was conducted with the facility's Consultant Dietitian (CD). The CD confirmed Resident #21's physician order to receive Jevity 1.5 at 65 ml/hr. for 20 hours, on at 8:00 AM and off at 4:00 AM. The Dietitian stated that in total the resident was to have 1300 cc of Jevity infused in 20 hours. The CD stated the nursing staff should be checking the feeding pump to make sure it was infusing as ordered. The CD was asked how do the staff know if Resident #21 was getting 1300 cc of Jevity in 20 hours. The CD stated that was a good question for nursing. During the interview, the CD was apprised that the floor nurse stated that not all nurses clear up the machine when a new bottle is connected. The CD was apprised that on 02/20/23 at 4:00 PM during medication administration observation for Resident #21, his Jevity bottle connected at 8:00 AM still had 1500 cc left to be infused. The CD stated that if the feeding formula was connected on 02/20/23 at 8:00 AM, by 4:00 PM, Resident #21 should have 520 cc of Jevity infused. The CD was apprised that the Jevity bottle was full (1500 cc) at the time. A side by side review of photographic evidence of Resident #21's feeding bottle taken on 02/21/23 at 11:57 AM was conducted with the CD. A side by side review of the resident Medication Administration Record (MAR) was conducted with the CD and revealed no documentation related to the amount of formula infused. The CD stated she will have to add for the nurses to document the amount of feeding infused. The CD was apprised that there was no monitoring of Resident #21's feeding on 02/20/23 and 02/21/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 11 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 5) Review of Resident #21 clinical record documented an initial admission to the facility on [DATE] with a latest readmission on [DATE] . The resident diagnoses included Parkinson's, Chronic Kidney Disease, Heart Disease, Dementia, Pain, Muscle wasting, Displaced Mid-cervical fracture of left femur with closed fracture routine healing and Anemia. Review of Resident #21's Minimum Data Set (MDS) admission assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 11, indicating that the resident had moderate cognition impairment. The assessment documented under Functional Status that the resident was total dependent on the facility's staff for his activities of daily living including, feeding and administration of medication via a feeding tube. On [DATE] at 4:10 PM, a medication administration observation for Resident #21 performed by Staff D, LPN was conducted. Observation revealed Staff D poured Namenda ( a memory medication) 10 milligrams (mg) and Seroquel 25 mg (an antipsychotic medication) into a medication cup and then crushed each medication individually. Staff D entered Resident #21's room with the crushed medication cups, placed the medication cups on top of the resident's table, and poured water over the crushed medications. At 4:24 PM, Staff D stated she needed her stethoscope and left Resident #21's room. Observation revealed Staff D left the residents crushed medications on top of the table and unattended. Observation reveled Staff D walked to the nurses station to retrieve her stethoscope and returned to Resident #21's room at 4:26 PM. The resident's roommate was out in the hallway by the door and was able to move around in a wheelchair and in and out of the room. On [DATE] at 12:33 PM, an interview was conducted with Staff D who acknowledged that she left Resident #21's medications unattended on top of the table on [DATE] to get her stethoscope. Staff D stated she was not supposed to and added it was her mistake. 6) On [DATE] at 9:34 AM, observation revealed the facility's treatment cart parked in the hallway near room [ROOM NUMBER], the cart was unlocked and unattended. Subsequently, observation revealed Staff G, LPN walked to the treatment cart, opened the cart drawers and retrieved wound care supplies to include normal saline vial, alcohol pads, Mupirocin 2 % ointment and a Sani Cloth- wipes jar. At 9:37 AM, observation revealed Staff G left the Sani cloth wipes jar on top of the treatment cart and did not lock the treatment cart before entering the resident's room. Consequently, observation revealed Staff G entered Resident #6's room, closed the door and walked to the bathroom to do hand hygiene and performed the resident's wound care. On [DATE] at 9:59 AM, observation revealed Staff G finished wound care for Resident #6 and exited the room. Observation revealed the treatment cart continue to be parked in the hallway near the resident's room and was unattended and unlocked. An interview was conducted with Staff G, who stated she left the treatment cart unlocked in case she needed something from the cart. Staff G added that she did not have the cart key. Observation revealed the treatment cart had multiple prescribed medications, ointment to include: Triamcinolone cream 0.5%, Benadryl cream 0.1%, Mupirocin 2%, [NAME] ointment, Hydrogel, Calcium Alginate, Dakin's solution 0.5% and Collagen. Based on review of policy and procedure, observation, interview and record review, it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 12 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few determined that the facility failed to 1) ensure that it secured over-the-counter (OTC) cream medication for 2 sampled residents observed, Resident #3 and Resident #37. 2) failed to ensure that it promptly secured the facility's Emergency medication box (E-kit) after use, during a Medication Administration Observation, for 1 of 1 Medication Storage Rooms, 3) failed to ensure that it discarded two expired stock OTC betadine swab stick packages in the facility's Medication Treatment Cart, 4) failed to ensure that it secured the facility's Treatment Medication Cart during Wound Care Observation; and 5) failed to secure routine medication during Medication Administration Observation, Resident #21. The findings included: Review of the facility policy and procedure on [DATE] at 4:21 PM titled LTC Facility's Pharmacy Services and Procedures Manual Storage and Expiration Dating of Medications, Biologicals [DATE]. provided by the Director of Nursing (DON) _______ reviewed [DATE] documented in the Policy Statement: Applicability This policy 5.3 sets forth the procedures relating to the storage and expiration dates of medications, biologicals, syringes and needles. Procedure: .3. General Storage Procedures: .3.3 Facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors .Bedside Medication Storage: 13.1 Facility should not administer/provide bedside medications or biologicals without a Physician/Prescriber order and approval by the Interdisciplinary Care Team and Facility administration. 13.2 Facility should store bedside medications or biologicals in a locked compartment within the resident's room [ROOM NUMBER]. Facility should ensure that medications and biologicals for expired or discharged or hospitalized residents are stored separately, away from use, until destroyed or returned to the provider. 16. Facility should destroy or return all discontinued, outdated/expired, or deteriorated medications or biologicals in accordance with Pharmacy return/destruction guidelines and other Applicable Law, and in accordance with Policy 8.2 (Disposal/Destruction of Expired or Discounted Medication). 1) Resident #3 was re-admitted to the facility on [DATE] with diagnoses which included Diastolic Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Bipolar Disorder, Schizophrenia, Hypertension and Dementia. She had a Brief Interview Mental Status (BIMS) score which deemed severely impaired. During an observational room tour on [DATE] at 10:06 AM, it was observed that there was an OTC Wound care cream medication left on Resident #3's bedside dresser. Photographic evidence was obtained. On [DATE] at 3:15 PM, it was still observed that there was an OTC Wound care cream medication left on the resident's bedside dresser. There was no order on the Resident #3's Medication Administration Record (MAR), nor on the Treatment Administration (TAR) for this OTC medication to be administered to this resident. 2) Resident #37 was admitted to the facility on [DATE] with diagnoses which included Encephalopathy, Epilepsy, Diabetes Mellitus Type II, Cardiomyopathy and Heart Failure. He had a Brief Interview Mental Status (BIMS) score of 14, indicating cognitively intact. During an observational room tour on [DATE] at 1:13 PM, it was observed that there were four (4) mini connected packages of OTC DermaRite Periguard Ointment cream medication containing Vitamins A, D, E, Aloe Vera and Zinc with an expiration date of 04/24 left on Resident 37#'s bedside dresser. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 13 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0761 Photographic evidence was obtained. Level of Harm - Minimal harm or potential for actual harm During an interview conducted on [DATE] at 1:15 PM, Resident #37, was asked whether or not the four (4) mini connected packages of OTC DermaRite Periguard Ointment cream medication containing Vitamins A, D, E, Aloe Vera and Zinc OTC cream medication was used for him. Resident #37 replied that it was not used for him, he did not know what it was for, nor why it was even there. Residents Affected - Few On [DATE] at 3:17 PM, it was still observed that there were four (4) mini connected packages of OTC DermaRite Periguard Ointment cream medication left on Resident #37's bedside dresser. On [DATE] at 9:23 AM, it was still observed that there were four (4) mini connected packages of OTC DermaRite Periguard Ointment cream medication left on Resident #37's bedside dresser. On [DATE] at 2:36 PM, it was still observed that there were four (4) mini connected packages of OTC DermaRite Periguard Ointment cream medication left on Resident #37's bedside dresser. On [DATE] at 9:45 AM, it was still observed that there were four (4) mini connected packages of OTC DermaRite Periguard Ointment cream medication left at the resident's bedside dresser. There was no order on Resident #37's Medication Administration Record (MAR), nor on the Treatment Administration (TAR) for this OTC medication to be administered to this resident. An interview was conducted on [DATE] at 1:58 PM consecutively with Staff C, a Licensed Practical Nurse (LPN), and with Staff D, an LPN/Unit Manager (UM) in which both acknowledged that neither Resident #3 nor Resident #37 should have had any un-secured medications left/placed at the bedside. In fact, the DermaRite Periguard Ointment cream medication packages were not removed from Resident #37's bedside dresser table, until after surveyor inquisition/intervention. 3) On [DATE] at 12:10 PM, during a Medication Administration Observation conducted with Staff D with one (1) of AHCA nurse surveyors, Staff D was observed removing the green plastic lock(s) from both the outer larger door of the E-kit box and then from the inner bottom fourth (4th) drawer the E-kit medication box which had an expiration date of [DATE]. However, after removing and signing out the medication from the E-kit, Staff D was not observed replacing any/either of the locks on the inner fourth (4th) drawer nor the outer larger door of the outside of the E-kit box located in the medication room, as they were found upon entry into the Medication room, as per facility protocol. Photographic evidence was obtained. On [DATE] at 12:23 PM, an interview was conducted with Staff C, in the Medication Storage room regarding the current status of the E-kit medication box in the room, which had been previously utilized by Staff D and, Staff C, was asked whether or not it was left un-locked/un-secured as it was found upon entry into the Medication room. Staff D said that she didn't see any locks to replace those on the outside of the larger E-kit medication box, and neither did she replace any locks on the outside of the inner fourth (4th) drawer, located in the E-kit box. On [DATE] at 12:33 PM, during an interview with Staff D by two (2) AHCA nurse surveyors, she was asked why she had not placed any locks on the outside of the E-kit medication box nor on the outside of the fourth (4th) drawer located within the larger E-kit box. She replied by saying that this was first time that she had ever gone into the E-kit to retrieve medication for the residents. She stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 14 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that she didn't see a replacement lock/tag for either the outside of the E-kit medication box and she also stated that neither were there any locks placed outside of the fourth (4th) drawer. Staff D acknowledged that the E-kit should have been locked after she was finished; this was not done. 4) On [DATE] at 2:10 PM a Medication Storage Observation was conducted of the Treatment Cart with the DON in which it was noted that there were two (2) OTC stock betadine swab stick packages located in the second drawer of the facility's Medication Treatment Cart with expiration dates of 09/2022. In fact, the E-kit was not locked, nor was the OTC expired medication discarded, until after surveyor inquisition/intervention. The DON further recognized and acknowledged that on [DATE] at 2:30 PM that the OTC resident medications should have been secured, the E-kit should be locked and secured at all times and expired OTC medications should have been discarded; this was not done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 15 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3) Review of Resident #13's clinical record documented an initial admission to the facility on [DATE] with a readmission on [DATE]. The resident's diagnoses included Dysphagia, Depression, Hemiplegia, Hemiparesis, Pressure Ulcer to the sacrum and Anemia. Residents Affected - Few Review of Resident #13's Minimum Data Set (MDS) quarterly assessment dated [DATE] documented a Brief Interview of the Mental Status (BIMS) score of 0, indicating that the resident had severe cognition impairment. The assessment documented under Functional Status that the resident needed extensive to total assistance from the staff for his activities of daily living (ADL) including eating. Review of Resident #13's care plan titled Resident has nutritional problem or potential nutritional problem related to an infection, pressure wounds, depression, anemia, mechanical altered diet, history of weight changes .initiated on 03/26/21 and last revision on 04/22/21. The care plan documented interventions to include The resident is able to feed self with set up . Review of Resident #13's care plan titled ADL self-care performance deficit related to Confusion, Dementia, Impaired balance initiated on 04/09/21. On 02/23/23 at 8:10 AM, observation revealed Resident #13 in bed, awake. Further observation revealed the resident's breakfast tray on top of his table and untouched. Attempted to interview, the resident but the resident did not answer questions asked. Further observation revealed Resident #13's roommate was eating and had eaten 90% of his breakfast at the time of the observation. On 02/23/23 at 8:31 AM, observation revealed Staff H, CNA in Resident #13's room. An interview was conducted with Staff H who stated she was going to feed the resident at that time. Staff H stated Resident #13's meal tray came to the floor with the rest of the residents trays, so his tray had been on table for more 21 minutes. Staff H stated she just finished feeding another resident and did not know Resident #13's tray was in his room. Resident #13 needed to be fed by the Staff H. On 02/23/23 at 8:34 AM, Staff H, CNA removed Resident #13's breakfast tray from his room to be warmed up. Based on observations, interviews, and record review, the facility failed to provide food and drink that is palatable, attractive, and at a safe and appetizing temperature for three residents during dining observations (Resident #7, Resident #3, and Resident #13). The findings included: 1. In an observation conducted on 02/22/23 at 7:55 AM, the first meal cart arrived on the unit. The breakfast tray was taken into Resident #7 ' s room and placed on the bedside table. Continued observation showed that at 8:25 AM, which was 30 minutes later, staff came into the room to assist Resident #7 with her breakfast meal. A record review showed that Resident #7 was admitted on [DATE], and the Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 7, which is cognitively impaired. Section G for eating showed that Resident #7 is totally dependent on staff for eating. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 16 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview conducted on 02/22/23 at 2:00 PM, during the resident council meeting, residents stated that there is always an issue with the meals being too cold and not hot enough when they come into the rooms. They further noted that the meal carts just stay in the hallway, and it takes 30 minutes to an hour before it is taken into the rooms. In an observation conducted on 02/23/23 at noon in the main dining room, the following was noted: the meal cart was noted on the side with some trays in them, and the meal cart cover was completely exposed. The main dining showed that 11 residents were eating their lunch meal. Staff A, a Certified Nursing Assistant (CNA), was in the dining room, pouring juices and iced tea from pitchers into cups and placing them on the meal trays that were left in the cart. At 12:23 PM, the meal cart was still noted in the main dining room, with trays on them for the other residents on the floor who did not get their lunch meal. At 12:28 PM, Resident #3 ' s lunch tray was taken into the room, and Resident #7 ' s lunch meal was still on the cart. Six more lunch trays were noted on the meal cart that were still not taken into residents ' rooms. At 12:32 PM, Staff Front Desk Coordinator brought Resident #7 ' s lunch tray into the room, which was 32 minutes after first meal cart came out of the kitchen. 2. A chart review showed that Resident #3 was readmitted on [DATE]. The MDS on 01/17/23 showed that she was severely cognitively impaired, and for eating under Section G, she is totally dependent on staff. Diagnoses of Dysphagia and Anorexia were noted as well. In an interview conducted on 02/23/23 at 3:00 PM with the facility ' s Administrator, she was told of the findings and stated that this had been an issue when she started, and she was aware of the residents complaining that the food was sitting outside the meal carts too long. In an interview conducted on 02/23/23 at 5:12 PM with the Clinical Dietitian, she stated that the plate warmers were not working to keep the food warm, and when asked if it is working now, she said she had to ask in the kitchen. When asked how long it should take for meals to be distributed to all residents during meal times, she needed to learn. When asked by the surveyor what the temperature of a meal sitting outside for 30 minutes was, she said it would be [NAME] warm. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 17 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to provide fortified foods for three residents during meal observation (Resident #7, Resident #1, and Resident #14). This has the potential to affect ten residents that are on fortified food diet orders. The findings included: A review of the Fortified Foods list provided by the facility showed that ten residents have a physician ' s order for fortified food with meals. In an observation conducted on 02/22/23 at 5:00 PM in the main kitchen, the Food Service Director/Cook was observed on the tray line plating the food on the plates and reading the meal tickets for each resident with gloves on. He was asked by Surveyor what is the fortified food for dinner, and he said it was the mashed potato and pointed to the metal container that was on the food warmer. A record review showed that Resident #7 was admitted on [DATE], and the Minimum Data Set (MDS) dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 7, which is cognitively impaired. Section G for eating showed that Resident #7 is totally dependent on staff for eating. Resident #7 had diagnoses of Dementia and Depression. A chart review showed that Resident #1 was readmitted to the facility on [DATE]. The MDS dated [DATE] showed a BIMS score of 14 which is cognitively intact. Resident had a Diagnosis of Anemia and Osteoporosis. A chart review showed that Resident #14 was admitted on [DATE]. The MDS dated [DATE] showed a BIMS score of 14, which is cognitively intact. Resident #14 had diagnoses of Heart Failure and Type 2 Diabetes. An observation conducted on 02/22/23 at 6:27 PM showed that Resident #7 received her dinner tray. The meal ticket showed an order for a Mechanical diet with fortified food. Closer observation of the dinner tray revealed it did not contain any fortified food (mashed potatoes) on the tray. An observation conducted on 02/22/23 at 6:20 PM showed that Resident #1 received his dinner tray. The meal ticket showed an order for a Mechanical diet with fortified food. Closer observation of the dinner tray revealed it did not contain any fortified food (mashed potatoes) on the tray. An observation conducted on 02/22/23 at 6:10 PM showed that Resident #14 received his dinner tray. The meal ticket showed an order for Regular No Added Salt Diet with fortified food. Closer observation of the dinner tray revealed it did not contain any fortified food (mashed potatoes) on the tray. In an interview conducted on 02/23/23 at 4:50 PM, the Clinical Dietitian stated that when she recommends adding fortified meals to residents, she will place it in the meal tracker system so the kitchen can get it and under Physician ' s orders so that it is attached to the diet order. In an interview conducted on 02/23/23 at 7:00 PM with the facility ' s Administrator, she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 18 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, it was determined that the facility failed to store, prepare, serve, and distribute food in accordance with professional standards for food safety that, include not keeping cold foods at the correct temperature of 41 degrees Fahrenheit and below, keeping personal items in the food production area, and practicing hand hygiene while handling food. The findings included: 1) During the initial kitchen tour on 02/20/23 at 9:27 AM, accompanied by, Dietary Manager, the following were noted: There was an accumulation of food residues on the sharpening stones of the slicer. There was a cooler containing water that had unidentified matter floating in the water. There was an accumulation of debris under the shelving in the dry storage area. The baseboard covering the floor and wall juncture by the three-compartment sink and the mechanical ware washing machine was not secured to the wall. Under the sanitizer basin of the three-compartment sink, the pipe was leaking directly onto the floor when the basin was dumped. 2) In a visit to the central kitchen, conducted on 02/22/23 at 4:45 PM, the following observations were noted: A personal cell phone was noted in the food production area. (Photographic evidence obtained). The Corporate Food Service Manager used the facility ' s Thermometer to take the temperature of 12 containers of pureed pears. The first container was recorded at 67.2 degrees Fahrenheit, and the second container was recorded at 65.9 Degrees Fahrenheit. This was not the correct temperature of 41 degrees and below for cold foods. In this observation, the Corporate Food Service Director grabbed all 12 containers and placed them in the outside freezer to cool down. In this observation, the Food Service Director/Cook said that the pureed pears were placed in the walk-in refrigerator the night before, and he took them out to puree them for the dinner meal. The Food Service Director/Cook was observed on the tray line plating the food on the plates and reading the meal tickets for each resident with gloves on. He was asked by the Surveyor what is the fortified food for dinner, and he said it was the mashed potato and pointed to the metal container that was on the food warmer. He then stopped the plating and said, this is not the fortified mashed potato; I need to make a serving of fortified mashed potatoes, and proceeded to walk towards the walk-in refrigerator and, with his gloved hand, opened the walk-in refrigerator to grab a bottle of milk. He also held a box of dry potatoes and started mixing the potatoes with half water and half milk. He finished making the Instant mashed potatoes and went back to the try line to continue plating the food with the same gloves he had on before. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 19 of 20 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 105578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Sea - Harbor Beach 1615 Miami Rd Fort Lauderdale, FL 33316 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 In an adtional tour of the kitchen, conducted on 02/23/23 at 10:20 AM, the following was noted: Level of Harm - Minimal harm or potential for actual harm A dirty rag was noted in the food production area and not in a sanitation bucket. (Photographic evidence obtained). Residents Affected - Few A red bucket with sanitation solution was tested by using an Hydrion tester for results that read parts per million from a range of 0 to 500. Continued observations showed that the test strip had a color that matched the 0 level, which was not within guidelines. In this observation, the Corporate Food Service Manager stated that more solution needs to be added to the red bucket. In an interview conducted on 02/23/23 at 7:00 PM with the facility ' s Administrator, she was informed of the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105578 If continuation sheet Page 20 of 20