Inspection·April 10, 2025

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. Based on observation, and interview, the facility failed to provide a homelike dining experience in the day/dining rooms on both nursing units for all residents who ate their breakfast and dinner meals there. This affected 29 residents at the two observed meals with the potential to affect all residents who chose to eat their meals in the unit's day/dining rooms. Findings: The facility's main dining room was noted during the survey dates from 4/08/25 to 4/10/25 not to be open for residents to eat their breakfast or dinner meals. For breakfast and dinner, residents were able to eat in the day/dining room on either of the two nursing units, or in their bedroom. On 4/08/25 at 8:10 AM, six residents were observed as they ate breakfast in the day room on the 100's unit. The meals for each resident were served with their dishes, drinks, and flatware left on the meal trays from which they ate, which created an institutional appearance. There were also no centerpieces or linen on the tables. A few minutes later, at 8:20 AM, twelve residents were observed as they ate breakfast in the 200's unit dayroom which also had no centerpieces or table linens and residents eating from trays at the tables. On 4/10/25 at 8:54 AM, eleven residents were observed as they ate breakfast in the 200's unit day/dining room with their meal dishes on their meal trays. A table with four residents eating their meal from their trays with the lids from the main plates stacked in the center of the table, instead of a centerpiece. The residents at the table stated they usually ate breakfast and sometimes dinner in the unit day rooms. They explained the tables were crowded with their trays and the lids on it. Resident #59 stated it was better at lunch when the trays were removed and the dishes with food were placed on the table. She stated they also used to have flower centerpieces on the table which made it nicer. On 4/10/25 at 8:56 AM, the Activities Director stated she never noticed that meal items were left on the trays during breakfast meal service, but was sure dishes, drinks and flatware were removed and placed on the tables during lunch at the main dining room. She added she would make sure to discuss making the environment more homelike in the unit dayrooms/dining rooms, with the Administrator. At 9:30 AM , the Administrator and Regional [NAME] President of Operations stated they were aware the unit dining areas were not homelike and were going to be ordering linen tablecloths for them. They stated they were also going to spruce up the environment with plants, art, and other decorations so the residents felt like it was their home and not like they were trapped in an institution. They stated they want it to be decorated for the resident's enjoyment. (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 3 Event ID: 105888 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 105888 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at St Cloud 4641 Old Canoe Creek Road Saint Cloud, FL 34769 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)