Health inspection·November 15, 2024

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and menu review, the facility failed to provide adequate portion size for the main lunch entree for Regular diets, with the potential to affect 46 residents on Regular diets. In addition, 3 of 10 sampled residents voiced food concerns regarding inadequate portions during survey ( Residents #3, #8 and #9). The findings included: 1. On 11/14/24 at 9:44 AM, an interview was conducted with Resident #3, he stated The facility doesn't give enough food; they need bigger portion. Record review revealed Resident #3 was admitted to the facility on [DATE] with diagnosis including diabetes. Review of the admission minimum data set assessment, reference date 10/30/24, recorded a brief interview for mental status score of score 15, which indicated Resident #3 was cognitively intact. Review of care plans evidenced Resident #3 had the potential of nutritional problem related to insulin dependent diabetes type 1, elevated blood sugar levels, and abnormal labs. Interventions included provide and serve diet as ordered (Regular diet). This care plan also documented Resident #3 had potential/actual impairment to skin integrity of fragile skin. Intervention included: encourage good nutrition and hydration in order to promote healthier skin. 2. On 11/14/24 at 11:38 AM, an interview was held with Resident #8. He stated he did have a problem with the portion of the food he received. He did not receive enough to eat. Review of clinical record for Resident #8 revealed, he was admitted to the facility on [DATE] with diagnosis including brain neoplasm (brain cancer). Review of the minimum data set assessment recorded a brief interview for mental status score of 15, which indicated Resident #8 was cognitively intact. Review of dietary care plan documented Resident #8 had nutritional problems or potential nutritional problems related to brain neoplasm. Interventions included: Provide and serve diet as ordered. 3. On 11/14/24 at 11:45 AM, an interview was conducted with Resident #9, he stated this place is costing him money because he must order out all the time. The facility did not give him enough food. The portions they give are for a child. He was always hungry, and he would like to have a snack at night. (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 2 Event ID: 105611 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 105611 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Greenacres 6414 13th Rd S Green Acres, 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)