Health inspection·October 2, 2023

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure there was sufficient dietary staff in place to carry out the functions of the food and nutrition service department. There was only one dietary aide and one cook in the kitchen preparing breakfast. The deficient practice resulted in breakfast being delivered to the nursing units more than 30 minutes late. This has the potential to affect one hundred and twenty three residents out of one hundred and thirty seven residents who eat orally residing in the facility. The findings included: Record review of the facility's policy titled Staffing Policy and Procedure (reviewed date 01/2023) documented: Policy Statement-Our facility provides sufficient numbers of staff with the skills and competency necessary to provide care and services for all residents in accordance with resident's needs. Policy Interpretation and Implementation-2) Staffing numbers and the skill requirements of direct care staff are determined by the needs of the residents based on each resident's plan of care and 3) Other support services (dietary) are also staffed to ensure that resident needs are met. Review of the Job Description for the Dietary/Food Service Director documented: The Dietary/Food Service Director is responsible for planning, preparing and serving regular, modified consistency and therapeutic diets using the corporate menu program. This position will ensure full compliance with nutritional standards, internal procedures and government regulations while preparing and serving foods and beverage to all patients/resident. He/she is also responsible to specify standards and procedures for food preparation and supervise preparation and serving of modified consistency and therapeutic diets. Review of the Job Description for the [NAME] documented: The [NAME] is responsible for preparing large volumes of food for patients/resident. Prepare food that is nutritious and desirable so that patients/residents get the food intake they need. Will prepare food for a preset menu, may make a variety of meals from menu, and/or prepare special meals for patient/residents who require therapeutic diets. He/she is also responsible to prepare food on large scale and cooks various items according to menus, special dietary or nutritional requirements or numbers of portions to be served. This position reports to the Director of Dietary. Review of the Job Description for the Dietary Aide documented: The Dietary Aide is responsible for providing meal service to residents. Will ensure full compliance with nutritional standards, internal procedures and government regulations while preparing and serving foods and beverages to all patients/residents. He/she is also responsible to prepare meals and beverages using specific procedures. Page 1 of 5 105711 105711 10/02/2023 Shoreside Health and Rehabilitation Center 201 NE 112th Street Miami, FL 33161

F 0802 This position reports to the Director of Dietary. Level of Harm - Minimal harm or potential for actual harm Review of the Job Description for the Dietitian documented: The Dietitian is responsible to monitor food service operations to ensure conformance to nutritional, safety, sanitation and quality standards, as well as all applicable state and federal regulations. He/she is also responsible for knowledge and understanding of regulatory process including all applicable federal, state and local regulations applicable to completing job responsibilities. This position reports to the Administrator and Dietary Consultant. Residents Affected - Some Observation of the kitchen on 10/02/23 at 7:01 AM revealed three dietary workers observed in the kitchen. The [NAME] (Staff A) was preparing breakfast foods. The Dietary Aide (Staff B) was pouring juice into cups and placing bread in the toaster for the breakfast tray line and Dietary Aide (Staff C) was at the high temperature dishwasher loading dishes and washing dishes. Three carts of dirty dishes and utensils were observed from the previous dinner meal service. The Food Service Director was not in the kitchen and there were no other dietary workers preparing for the breakfast tray line. On 10/02/23 at 7:02 AM, interview with the Cook, Staff A. He stated, I only have two workers to help with breakfast. There should be more. We are running behind on breakfast. I am just the cook. The breakfast line should have started before now at 6:30 AM-7:30 AM. It is going to be very late because they have to wash dishes and pour the juice, before we can start the breakfast line. I have been working here for sixteen years. On 10/02/23 at 7:09 AM, interview with the Dietary Aide, Staff B. She stated, I have worked here for twenty-two years. We use to have five workers at breakfast and at the beginning of the year, they cut it to three people. We need more workers. We can't do this by ourselves. You see all the carts of dirty trays. The dishes have to be washed before we can start breakfast. They only have three people in the evening, that is why the dirty dishes are still here. On 10/02/23 at 7:14 AM, interview with the Dietary Aide, Staff C. He stated, When I come in the morning, I have to wash the dishes before they start breakfast. I have been working here for twenty-four years. We need more people to work in the kitchen. Observation of the Cook, Staff A on 10/02/23 at 7:31 AM placing pans of food on the breakfast tray line. On 10/02/23 at 7:34 AM, interview with the Registered Dietitian, Staff D. She stated, I have been here since August 30, 2023. We are fully staffed today. There are only three workers in the kitchen at this time. The breakfast trays are late today. I check the menus daily to make sure they are being followed. The Food Service Director lets me know if there are changes. I check the modified diets and if there any substitutions made, I am notified. I oversee the Food Service Director. I don't know the number of workers that are supposed to be working in the kitchen. Observation on 10/02/23 at 7:39 AM revealed the breakfast tray line was started. Three dietary workers were observed on the breakfast tray line. The Dietary Aide (Staff B) was observed preparing the trays, [NAME] (Staff A) was serving the food on the tray line and Dietary Aide (Staff C) who was observed washing dishes, placed the breakfast food trays on the food cart for delivery to the units. Observation on 10/02/23 at 7:40 AM revealed the breakfast trays consisted of: Scrambled eggs, Cream of Wheat, Sliced Toast, Boiled Eggs, Orange Juice, Milk, Oatmeal, Fruit Cup. No meat was observed 105711 Page 2 of 5 105711 10/02/2023 Shoreside Health and Rehabilitation Center 201 NE 112th Street Miami, FL 33161

F 0802 on the tray line. Level of Harm - Minimal harm or potential for actual harm Observation on 10/02/23 at 7:45 AM revealed another dietary aide enter the kitchen. This brought the total of dietary workers to four in the kitchen. Residents Affected - Some Observation on 10/02/23 at 7:47 AM revealed the Food Services Director enter the kitchen. Review of the Meal Times schedule to be served documented the following: Breakfast: Unit A 7:00 AM to 7:30 AM, Unit B 7:30 AM to 8:00 AM and Unit C 8:00 AM to 8:30 AM. Observation on 10/02/23 at 7:58 AM revealed the breakfast trays arrived on Unit A. The breakfast trays for Unit A were scheduled to arrive 7:00 AM-7:30 AM. Observation on 10/02/23 at 8:02 AM revealed the staff delivering breakfast trays to the residents on Unit A. Observation and interview of Resident #1 on 10/02/23 at 8:05 AM residing on Unit B, revealed the resident sitting in a motorized wheelchair in his room, wearing glasses and a hat. Resident was waiting for breakfast to be served. He stated, It is pretty late for breakfast. Breakfast usually arrives around 8:30 AM to 9:00 AM. I have been here since Christmas. I am hungry now. I have snacks here that my family brings for me. They have always served breakfast since I have been here but not much is served. On 10/02/23 at 8:12 AM, interview with Licensed Practical Nurse (LPN), Staff E on Unit B. She stated, The breakfast is usually late. It is supposed to be here by 8:00 AM. Observation on 10/02/23 at 8:27 AM revealed the breakfast trays arrived on Unit B. The breakfast trays for Unit B were scheduled to arrive 7:30 AM-8:00 AM. Observation on 10/02/23 at 8:30 AM revealed the staff delivering breakfast trays to the residents on Unit B. Observation and interview of Resident #2 on 10/02/23 at 8:46 AM residing on Unit C, revealed the resident sitting in a motorized wheelchair in the Unit C dining room, with missing teeth. Resident was waiting for breakfast to be served. He stated, Breakfast is always late. I am hungry right now. I have been here since 2019. Observation on 10/02/23 at 9:07 AM revealed the breakfast trays arrived on Unit C. The breakfast trays for Unit C were scheduled to arrive 8:00 AM-8:30 AM. Observation on 10/02/23 at 9:10 AM revealed the staff delivering breakfast trays to the residents on Unit C. Review of the 4 Cycle Menus for Week 4 Monday Breakfast Menu documented: Scrambled Eggs, Bacon Sliced (for Regular Diet), Sausage Patty (for Chopped Diet, Mechanical Soft diet and Pureed diets), Whole Wheat Toast 1 slice, Cream of Wheat, Coffee, Fruit Juice, Milk Whole, Boiled Egg, Cold Cereal Bowl and Fruited Yogurt. On 10/02/23 at 9:51 AM, interview with the Food Services Director (FSD). He stated, Three diet 105711 Page 3 of 5 105711 10/02/2023 Shoreside Health and Rehabilitation Center 201 NE 112th Street Miami, FL 33161

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some aides and one cook is scheduled to work for breakfast for a total of four. One of the staff members called in this morning and I called someone else to come in this morning. We have a lot of patients who are slow eaters and trays are left over from the night before. Fourteen workers work in the kitchen. Four people work in the afternoon for the dinner shift. The people in the morning work for the breakfast and lunch shift. We always serve breakfast. Attendance is good but once in a while someone will call out. Breakfast was late this morning because someone called out. Review of the Demographic Face Sheet for Resident #1 documented the resident was admitted on [DATE] with a diagnosis of hemiplegia, multiple sclerosis, cardiomyopathy hypertension, muscle weakness, dysphagia, major depressive disorder, atherosclerotic heart disease and anxiety disorder. Review of the Minimum Data Service (MDS) Quarterly assessment dated [DATE] for Resident #1 documented the resident's Mental Status (BIMS) Summary Score was 15, indicating no cognitive impairment and he was able to make his needs known and he required extensive assistance to total dependence with one person physical assist for adls (activities daily living) and limited assistance with one person physical assist for eating. Review of the Demographic Face Sheet for Resident #2 documented the resident was admitted on [DATE] with a diagnosis of hemiplegia, peripheral vascular disease, hypertension, atherosclerotic heart disease and osteoporosis. Review of the Minimum Data Service (MDS) Quarterly assessment dated [DATE] for Resident #2 documented the resident's Mental Status (BIMS) Summary Score was 15, indicating no cognitive impairment and he was able to make his needs known and he required limited assistance to total dependence with one person physical assist for adls (activities daily living) and supervision with setup help only for eating. Review of the Resident Council Meeting Minutes dated January 2023-October 2023 documented the following: 1) At the 2/23/23 meeting, the former Food Service Director discussed upcoming changes in the kitchen. He emphasized the collaboration of the dietary department to ensure the timely delivery of food trays at nursing stations; 2) At the 3/29/23 meeting, the former Registered Dietitian (RD) discussed upcoming changes in the kitchen. She emphasized the collaboration of the dietary department to ensure the timely delivery of daily food trays at nursing stations. Feedback and Concerns from the resident: Residents expressed concerns over meals not being delivered on a timely manner when they get to the nursing stations. Review of the Facility Assessment, updated 3/29/23 documented there were 14 Dietary staff and the Nutrition department provided individualized dietary requirements, liberal diets, specialized diets, cultural or ethnic dietary needs. On 10/02/23 at 11:00 AM, interview with the Consultant RD (Registered Dietitian). She stated, The FSD is not a CDM (Certified Dietary Manager). She [RD, Staff D] is overseeing the kitchen. She has only been here for a month. Our staffing pattern is meeting industry standards with 4 scheduled in the morning and they should be able to function. My responsibilities is help to oversee the kitchen for compliance. During the interview the Consultant RD became very upset and proceeded to cry over the status of the kitchen. Subsequent interview on 10/02/23 at 11:39 AM. She stated, There is a total of 14 staff that work in the kitchen plus the Food Service Director which brings the total to 15 workers in the kitchen. There are 4 workers scheduled in the morning for breakfast, 4 workers scheduled in the afternoon for dinner with 8 people total for the whole day. 105711 Page 4 of 5 105711 10/02/2023 Shoreside Health and Rehabilitation Center 201 NE 112th Street Miami, FL 33161

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation on 10/02/23 at 11:53 AM revealed the lunch tray line was in progress. Three dietary workers and the Food Service Director were observed on the lunch tray line for a total of 4 workers. Seven dietary workers plus the Food Service Director were observed in the kitchen for a total of eight workers for lunch. Observation and interview of Resident #3 on 10/02/23 at 11:58 AM residing on Unit A, revealed the resident lying in bed and watching television. He stated, Yes, I am the Resident Council President. The breakfast comes between 8:00 AM-8:30 AM. In resident council meetings, certain people would complain about breakfast being served late. I have been here for four years. Review of the Demographic Face Sheet for Resident #3 documented the resident was admitted on [DATE] with a diagnosis of multiple sclerosis, osteoporosis, major depressive disorder and osteoarthritis. Review of the Minimum Data Service (MDS) Quarterly assessment dated [DATE] for Resident #3 documented the resident's Mental Status (BIMS) Summary Score was 15, indicating no cognitive impairment and he was able to make his needs known and he required extensive assistance to total dependence with one person physical assist for adls (activities daily living) and supervision with setup help only for eating. On 10/02/23 at 1:48 PM, interview with the Human Resources (HR) Consultant. She stated, On 1/01/23, we had ten dietary aides, three dietary cooks and one director of dietary services employed. On 10/02/23, we have nine dietary aides, four dietary cooks and one director of dietary services employed. On 10/02/23 at 2:47 PM, interview with the Director of Nursing (DON). She stated, I have been here one year. The only time I notice breakfast is late is when the food service director comes in to assist when someone calls out. I agree that breakfast was late today, more than 30 minutes. On 10/02/23 at 3:05 AM, interview with the Administrator. She stated, I have been here seven months. Someone did call out today in the kitchen and that made breakfast late. 105711 Page 5 of 5