Inspection·November 10, 2021

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and staff interview the facility failed to provide assistance for grooming and nail care for 2 (Resident #15 and #18) of 2 dependent residents reviewed for activities of daily living. Residents Affected - Few The findings included: 1. On 11/8/21 review of Resident #15's care plan noted the resident has limited physical mobility related to exacerbation of Parkinson's, dementia. The care plan revised on 4/2021 also noted the resident required assistance of one to two with all activities of daily living. On 11/8/21 at 3:23 p.m., Resident #15 was observed in a wheelchair. Resident was not able to answer questions. The Resident's fingernails were uneven and extended approximately half centimeter from the base with a large accumulation of brown substance underneath the nails. Resident #15 was observed scratching her arms and shoulders. The same observation was made on 11/9/21 at 2:20 p.m., and 11/10/21 at 9:00 a.m. 2. On 11/8/21 review of Resident #18's care plan dated 10/24/21 noted the resident had limited physical mobility related to weakness and poor sight. The care plan also noted Resident #15 had impaired cognitive function, dementia and impaired thought process related to dementia. On 11/8/21 at 3:25 p.m., Resident #18 was observed in a wheelchair. Resident was not able to answer any questions. The resident's hair had a large amount of white flakes. The resident's nails were uneven and extended approximately half centimeter from the base with brown substance observed underneath the nails. The same observation was made on 11/9/21 at 2:20 p.m., and 11/10/21 at 9:00 a.m. Complete record review for Resident #18 and #15 failed to show documentation of nail care. On 11/10/21 at 9:30 a.m., in an interview the Director of Nursing (DON) said CNA Staff G and the restorative nurse oversee nail care. She said there is no written policy or process for nail care but the need for nail care should be documented on a skin care sheet. The DON verified Resident #15 and #18's nails needed to be trimmed and cleaned. On 11/10/21 at 10:00 a.m., in an interview Certified Nursing Assistant (CNA) Staff G said she trims nails as needed but there was no process for routine nail care for residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105955 If continuation sheet Page 2 of 3 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 105955 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advinia Care at Venice 950 Pinebrook Road Venice, FL 34285 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, review of facility's policy and procedure and staff interview the facility failed to maintain safe food temperature during preparation of meal, and failed to discard expired food items to prevent their use beyond the manufacturer's specified safe use date. The findings included: The facility's policy for Meal Service and Snacks with a revision date of 1/2021 read, . The Dietary department shall be responsible for food preparation for all meals and snacks . On 11/8/21 at 12:30 p.m., observation of the food prep area showed one tray of egg salad sandwiches on a table in the food preparation area. Upon request the Certified Dietary Manager (CDM) measured the temperature of the egg salad sandwiches which measured at 54 degrees Fahrenheit (F). The CDM verified the cold food should be held at 41 degrees F or lower. He placed the sandwiches back in the refrigerator. On 11/8/21 at 12:40 p.m., observation of the satellite kitchen with the CDM revealed the following: An opened, undated bottle of honey mustard sauce with a large accumulation of black/greenish substance around the lid. Resident #2's name was written on the bottle. Photographic evidence obtained An opened bottle of chocolate syrup with an expiration date of 9/6/21. A large accumulation of green and black growth was observed around the cap. Photographic evidence obtained On 11/8/21 at approximately 12:40 p.m., in an interview dietary aide staff E said she was responsible to check the expiration date of refrigerated product. She said, I know but haven't had the time to get to it. On 11/8/21 at 12:45 p.m., the CDM verified the observation and said residents' food items should not be stored in the satellite kitchen's refrigerator. The CDM discarded the chocolate syrup and the honey mustard sauce. On 11/10/21 at 10:15 a.m., observation of the medication room with Licensed Practical Nurse (LPN) Staff C showed 98 packages of soft baked cookies with an expiration date of 7/2021 which she said were residents' snacks. On 11/10/21 at 11:03 a.m., in an interview the Registered Dietitian (RD) said the dietary department had the responsibility to verify the expiration date of foods and snacks. The RD said the egg salad sandwiches should not have been used and residents should have been given a new sandwich. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105955 If continuation sheet Page 3 of 3