Inspection·July 15, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interviews, document review, and facility policy and procedure review, the facility failed to maintain a sanitary and comfortable environment for residents and staff by failing to ensure hot water was available in resident rooms, resident shower rooms and employee bathrooms. This deficient practice had the potential to impact all 51 residents residing in the facility at the time of the survey. The findings include:On 07/14/25 at 12:41 PM, water temperatures in the facility were taken in the presence of the Regional Plant Operations. Using a dial stem thermometer, resident bathrooms, shower rooms and employee hand washing stations were measured and revealed the following:East Sideroom [ROOM NUMBER]: 78 [NAME] #2: 78 [NAME] #3: 91 [NAME] #4: 78 FRooms #5 and #7 (Jack and [NAME]/ shared bathroom): 70 FRooms #6 and #8: 80 FRooms #10 and #12: 80 [NAME] Side Shower Room: 78 FEmployee Restroom [ROOM NUMBER]: 80 FEmployee Restroom [ROOM NUMBER]: 80 FWest SideRooms #16 and #18: 78 FRooms #19 and #21:100 FRooms #20 and #22: 80 FRooms #24 and #26: 78 [NAME] #27: 98 FWest Side Shower Room: 90 [NAME] 07/14/25 at 11:01 AM, an interview was conducted with Employee C, who works in housekeeping. He reported he has worked at the facility for almost a year and complained that the lack of hot water affects his ability to clean effectively. He especially has a hard time waxing the floors, as he cannot use cold water for the waxing process and has to go to the kitchen to obtain hot water to wax the floors. On 07/14/25 at 11:04 AM, an interview was conducted with Employee B, CNA, who reported she has worked at the facility for 11 months and explained that the hot water has not worked since she started working at the facility. The shower room on the east and west hallway get somewhat warm and many resident bathrooms don't have hot water. Residents often refuse incontinent care or bed baths because they don't want to be bathed in cold water. A resident recently yelled at her that she was cruel for using cold water for incontinent care. She explained that residents are supposed to receive 2 showers each week. On 07/14/25 at 11:12 AM, an interview was conducted with the Infection Control Preventionist/Wound Care, RN, who reported she has worked at the facility since December of 2024. The lack of hot water has been a problem from the start and felt that the lack of hot water may affect effective infection control, as hot water is needed for all aspects of infection control. The lack of hot water forced CNAs to switch from using wash clothes with warm water to using disposable wipes. On 07/14/25 at 11:22 AM, an interview was conducted with Employee A, RN, who reported she has worked at the facility since September of 2024. She explained that the lack of hot water makes her job difficult. Residents have been complaining about the lack of hot water since she started working at the facility. Residents have refused incontinent care and hygiene assistance because they complain the water is too cold. During the last staff meeting, the Maintenance Director informed staff that the facility will soon spend $50K to fix the plumbing. On 07/14/25 at 1:15 PM, an interview was conducted with the Regional Plant Operations, who reported he has worked as the Regional Plant Operations for 1 1/2 years. He explained that he oversees the maintenance of (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: 105665 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 105665 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at South Daytona 650 Reed Canal Rd South Daytona, FL 32119 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)