Inspection·August 12, 2021

F 0600 The overbed table had capsized into the bed and Resident #19 was holding onto it with the left hand. Level of Harm - Actual harm The meal tray was in the bed with the dishware, utensils and breakfast food items scattered in the bed. The bed linen was soaking wet and soiled. The room remained with a strong smell of urine. Residents Affected - Few The surveyor turned on the call light and called for assistance from the doorway. No staff was observed in the 4 hallways to assist Resident #19. On 8/10/21 at 12:50 p.m., staff had not responded to the call light and surveyor's calls for assistance for the resident. Resident #19's room was directly across from the nurses' station. Licensed Practical Nurse (LPN) Staff R was observed at the nurses' station. Resident #19's call light remained on and was clearly visible and audible at the nurse's station. LPN Staff R did not respond to the call light or the surveyor's request for immediate assistance for Resident #19. Upon request for assistance, LPN Staff R said she would find a Certified Nursing Assistant (CNA) to help but they were currently busy delivering lunch meal trays to the residents and walked away. LPN Staff R did not go in the room to evaluate Resident #19 and did not send a CNA for help despite the request for assistance. On 8/10/21 at 12:55 p.m., the North Wing Unit Manager LPN Staff I donned personal protective equipment (PPE) and entered Resident #19's room. Staff I left the room and called out for help. Resident #19 remained face down across the head of the bed and shivering. On 8/10/21 at 12:58 p.m. Staff I activated the emergency call signal and stayed with Resident #19. On 8/10/21 at 1:00 p.m., LPN Staff I instructed LPN Staff R to assist her. They pulled up the resident from the bed and placed him in a wheelchair. A large area of red discoloration was observed across the resident's chest. Resident #19 was still shaking, complained he was cold, and said his chest was hurting. On 8/10/21 at 1:05 p.m., CNA Staff K removed the wet linen. The mattress remained visibly wet. CNA Staff K placed clean linen on the wet mattress and assisted Resident #19 back to bed. On 8/10/21 at 1:15 p.m., in an interview CNA Staff K said she usually worked as an activity's assistant and was assigned to screen visitors that day at the rear entrance of the facility. She said on 8/10/21 at 10:00 a.m., she was pulled to work as a CNA on the South Unit but did not realize Resident #19 was assigned to her. CNA Staff K said she looked at the board, missed Resident #19's room and did not provide care to the resident until she was called to the room at 1:05 p.m. CNA Staff K said the night shift CNA had already left and she did not get report on her assigned residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 2 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0600 Level of Harm - Actual harm Residents Affected - Few On 8/10/21 at 1:30 p.m., in an interview, LPN Staff R said she administered medications to Resident #19 at approximately 9:30 a.m. and did not check on him again. LPN Staff R said she was from an agency, did not know Resident #19 and walked away from the interview. On 8/11/21 at 10:00 a.m., a review of the Physician progress note dated 8/10/21 documented, Patient (Resident #19) is seen for a fall. It involved his bedside table; he may have fallen on the floor on his right side. When I saw him, he was on the bed on his right side. Nurse is concerned of Patient's positioning and cough. Patient denies pain. Pt [patient] does have dementia. The Physician ordered a chest x-ray and to continue to monitor the resident. On 8/11/21 at 3:43 p.m., in an interview, the Director of Nursing reviewed the clinical record and confirmed there was no documentation Resident #19 received CNA care on 8/9/21 after 11:59 p.m., through 8/10/21 until 1:05 p.m. She verified the lack of oversight on the unit with agency nurse assigned to the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 3 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Actual harm 3. On 8/10/21 at 11:39 a.m., in an interview, Resident #63 said she wished she could get a bed bath and have her hair washed. She said she could not remember the last time her hair was washed. She said she had even asked for a good bed bath, but they did not give her one. Resident #63 denied receiving showers since she did not get out of bed. Residents Affected - Few On 8/10/21 at 11:40 a.m., observed Resident #63 laying in her bed with her head slightly elevated. Her hair was pulled up on top her head, looked stringy and unkempt. The Resident was alert, she was dressed in hospital gown and covered with a sheet. A review of Resident #63's medical record, showed the resident was scheduled for bathing or showering twice a week on Tuesday and Friday. The Certified Nursing Assistant (CNA) Kardex (area where care need is described), recorded the resident preferred bed baths and required assist of 1 staff member for the task. Review of Resident #63's documented bathing schedule recorded in the prior 28 days the resident received 2 bed baths (7/29/21 and 8/3/21) and a shower on 8/7/21 and 8/8/21. On 8/11/21 at 10:50 a.m., in interview, the LPN South Unit Manager Staff T said she reviewed the CNA documentation for the prior 28 days and verified the lack of documentation Resident #63 received a shower or bed bath as scheduled twice a week. LPN Staff T said the resident did not like showers so she should have received bed baths which would include washing her hair. Based on observation, record review, staff and resident interviews, the facility failed to provide the necessary care and services to maintain grooming and personal hygiene for 3 (Resident #19, #42 and #63) of 17 sampled residents. The findings included: 1. A review of the clinical record for Resident #19 documented a care plan indicating Resident #19 had an Activities of Daily Living (ADL) self-care performance deficit due to confusion and dementia. The care plan interventions noted Resident #19 required extensive assistance of 1 for bathing, dressing, and toileting. The care plan also documented Resident #19 had alteration in communication related to severe dementia, confusion/delusions and his needs must be anticipated by staff. On 8/10/21 at 9:41 a.m., Resident #19 was observed in his room standing next to his bed eating breakfast with his fingers. The linen on the bed was soaked with urine and the room had a pungent odor of urine. Resident #19 had a hospital gown tied around his neck and hanging down his chest. The incontinent brief was overly saturated with urine and feces and was pulling down to the resident's knees. Resident #19's fingernails extended approximately 1/2 inch from the base with dark brown substance underneath. He had facial hair growth of approximately three days. He was not able to answer questions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 4 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0677 Level of Harm - Actual harm On 8/10/21 at 12:35 p.m., in a second observation Resident #19 was observed lying face down across the head of the bed with his toes touching the floor. The resident was not dressed, he was shivering, and the incontinent brief remained oversaturated with urine and feces. Residents Affected - Few The overbed table had capsized into the bed and Resident #19 was holding onto it with the left hand. The meal tray was in the bed with the dishware, utensils and breakfast food items scattered in the bed. The bed linen was soaking wet and soiled. The room remained with a strong smell of urine. The surveyor turned on the call light and called for assistance from the doorway. No staff was observed in the 4 hallways to assist Resident #19. On 8/10/21 at 12:50 p.m., staff had not responded to the call light and surveyor's calls for assistance for the resident. Resident #19's room was directly across from the nurses' station. Licensed Practical Nurse (LPN) Staff R was observed at the nurses' station. Resident #19's call light remained on and was clearly visible and audible at the nurse's station. LPN Staff R did not respond to the call light or the surveyor's request for immediate assistance for Resident #19. LPN Staff R said she would find a Certified Nursing Assistant (CNA) to help but they were currently busy delivering lunch meal trays to the residents and walked away. LPN Staff R did not go in the room to evaluate Resident #19 and did not send a CNA for help despite repeated requests for assistance. On 8/10/21 at 12:55 p.m., the North Wing Unit Manager LPN Staff I donned personal protective equipment (PPE) and entered Resident #19's room. Staff I left the room and called out for help. Resident #19 remained face down across the head of the bed and shivering. On 8/10/21 at 12:58 p.m. Staff I activated the emergency call signal and stayed with Resident #19. On 8/10/21 at 1:00 p.m., LPN Staff I instructed LPN Staff R to assist her. They pulled up the resident from the bed and placed him in a wheelchair. A large area of red discoloration was observed across the resident's chest. Resident #19 was still shaking, complained he was cold, and said his chest was hurting. On 8/10/21 at 1:05 p.m., CNA Staff K removed the wet linen. The mattress remained visibly wet. CNA Staff K placed clean linen on the wet mattress and assisted Resident #19 back to bed. On 8/10/21 at 1:15 p.m., in an interview CNA Staff K said she usually worked as an activity's assistant and was assigned to screen visitors that day at the rear entrance of the facility. She said on 8/10/21 at 10:00 a.m., she was pulled to work as a CNA on the South Unit but did not realize Resident #19 was assigned to her. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 5 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0677 Level of Harm - Actual harm Residents Affected - Few CNA Staff K said she looked at the board, missed Resident #19's room and did not provide care to the resident until she was called to the room at 1:05 p.m. CNA Staff K said the night shift CNA had already left and she did not get report on her assigned residents. On 8/10/21 at 1:30 p.m., in an interview, LPN Staff R said she administered medications to Resident #19 at approximately 9:30 a.m. and did not check on him again. LPN Staff R said she was from an agency, did not know Resident #19 and walked away from the interview. On 8/11/21 at 10:00 a.m., a review of the Physician progress note dated 8/10/21 documented, Patient (Resident #19) is seen for a fall. It involved his bedside table; he may have fallen on the floor on his right side. When I saw him, he was on the bed on his right side. Nurse is concerned of Patient's positioning and cough. Patient denies pain. Pt [patient] does have dementia. The Physician ordered a chest x-ray and to continue to monitor the resident. On 8/11/21 at 3:43 p.m., in an interview, the Director of Nursing reviewed the clinical record and confirmed there was no documentation Resident #19 received CNA care on 8/9/21 after 11:59 p.m., through 8/10/21 until 1:05 p.m. She verified the lack of oversight on the unit with agency nurse assigned to the resident. 2. A review of the clinical record for Resident #42 documented diagnoses of morbid obesity, left and right hip contractures, and was not able to ambulate. The clinical record showed a care plan that specified the resident required extensive assistance with his activities of daily living (ADL) care. On 8/9/21 at 12:02 p.m., Resident #42 was observed in bed with two urinals hanging above his head from the trapeze bar (used to help a person reposition in bed). One urinal was approximately halfway filled with urine. Resident #42 said no one would come to empty them when he put the call light on. Resident #42 said he would wait over 30 minutes to an hour for assistance and was concerned the urinal would fall and urine would spill on his head. Resident #42 said he always placed the urinals on the trapeze bar so he could reach them. On 8/10/21 at 10:34 a.m., in an interview Resident #42 said his roommate had a different Certified Nursing Assistant (CNA) assigned to his care. Resident #42 said when his roommate's CNA was in the room helping his roommate, he asked to empty the urinal, but the CNA refused. Resident #42 said the roommate's CNAs told him they were not assigned to his care and instructed him to put his call light on. The resident said he put call light on, and no one would come. Resident #42 said his main concern was, the staff did not help him when they were in the room to assist his roommate. On 8/10/21 at 10:40 a.m., in an interview, CNA Staff L said, what he is saying is true, I've seen it with my own eyes. If (Resident # 42) asked the roommate's CNA for assistance with something, they tell him, I don't have you and walk out. Staff L said she had worked at the facility a long time and that was what the other CNAs did. Staff L said when she was assigned the split assignment, and Resident #42 needed something she would do it for him. Staff L said many of the agency CNAs just walked right out of the room, they didn't want to mess with him if they were not assigned to him. On 8/11/21 at 9:59 a.m., in an interview the South Unit Manager LPN Staff T said she split the room (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 6 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0677 Level of Harm - Actual harm to even out the CNA assignments. Staff T said she was not aware of a problem with the split room assignment. Staff T said Resident #42 would make up stories and it was in his care plan that he had that behavior. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 7 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, the facility failed to provide Restorative Nursing Program as recommended by Rehabilitation Therapy to prevent decline and maintain abilities with Activities of Daily Living (ADLs) for 1 (Resident #38) of 2 residents reviewed. This has the potential to lead to a decline in functional ability. The findings included: The facility Restorative Nursing Services policy (RN-100, revised 8/24/17) directs: Restorative Nursing will be provided to residents as indicated upon evaluation to assist in achieving the highest practicable level of physical functioning as possible. The procedure includes: Therapy may refer a resident to restorative upon discharge from therapy services as deemed appropriate. When being referred by a therapist: Therapist will complete Communication to Restorative Nursing Form Therapist will review with the Restorative Aid After review, the Therapist, Restorative Nurse and Restorative Aide will sign the form. On 8/9/21 at 9:35 a.m., on 8/9/21 at 1:30 p.m., on 8/10/21 at 12:12 p.m., on 8/10/21 2:25 p.m., and on 8/11/21 10:00 a.m., Resident #38 was observed lying in bed on his back. Resident #38 was observed randomly throughout the survey, and no staff was noted to be doing exercises with him. Review of Resident #38's clinical record indicated he was re-admitted on [DATE] and received Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST). He was discharged from PT/OT and ST. A Restorative Nursing Program (RNP) referral was made on 7/21/21 for upper extremities therapeutic exercises. The Restorative Nursing Program included upper and lower extremities exercises with a goal to maintain Bilateral Upper Extremities (BUE) and Bilateral Lower Extremities (BLE) strength. The form bore a staff member's signature verifying the person received training on the procedure for the Restorative program developed by the Physical and Occupational therapists. On 8/12/21 at 9:30 a.m., in an interview, Director of Rehabilitation Services stated Resident #38 was discharged from therapy on 7/21/21 and recommendations were given to the Restorative Department. On 8/12/21 at 11:23 a.m., in an interview the Nursing Restorative Aide (NRA) Staff S said Resident #38 did not appeared on the list of residents who completed the restorative nursing program or on the list of residents currently receiving restorative nursing services. On 8/12/21 at 12:15 p.m., in an interview, the North Wing Unit Manager Staff I and the Restorative Aide Staff S confirmed Resident #38 was not on a RNP. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 8 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on record review, facility policy review, and staff and resident interviews, the facility failed to have documentation of a fall investigation to ensure adequate preventive interventions for 1 (Resident #5) of 2 residents reviewed for falls. The findings included: Review of the facility policy and procedure, Fall Management, revised 7/29/19 which stated, . A fall refers to unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of an overwhelming external force (e.g., [for example] resident pushes another resident). An episode where a resident lost his/her balance and would have fallen, if not for another person or if her or she had not caught him/herself, is considered a fall. On 8/9/21, at 9:35 a.m., Resident #5 was observed in a wheelchair by her bed. The bed was not in the lowest position. At the time of the observation, Resident #66 (Resident #5's roommate) said Resident #5 sustained a fall the evening before. She said, I put on my call bell when I saw her falling. No one came so I also put on her call bell. Then when still no one came to help her, I went to the hall and got the nurse. Resident #5 confirmed during the roommate's interview she fell the evening before. On 8/9/21 clinical record review showed Resident #5 had an admission date of 4/30/21, with diagnosis including generalized muscle weakness and lack of coordination. Resident #5's care plan for fall showed an update on 5/6/21 to include interventions for actual fall. Review of incidents and accidents report did not show any falls for Resident #5. The Facility Matrix (identifies pertinent care categories) documented resident #5 had a fall. Records reviewed for Resident #66 documented a Brief Interview for Mental Status (BIMS) score of 13 indicating intact cognitive response ability. On 8/11/21, at 9:00 a.m., in an interview Certified Nursing Assistant (CNA) Staff E assigned to Resident #5 said she received report on 8/9/21 in the morning Resident #5 sustained a fall on 8/8/21 in the evening. CNA Staff E said, I checked her all over on Monday (8/9/21) when I gave her a shower and I did not see any bruises on her. On 8/11/21, at 9:26 a.m., in an interview Registered Nurse (RN) Staff F said, As far as I know Resident #5 did not fall. I was not told she had fallen on Sunday (8/8/21) in report Monday (8/9/21) morning. On 8/11/21 at 1:33 p.m., in a telephone interview Licensed Practical Nurse (LPN) Staff G said she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 9 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was assigned to Resident #5 on 8/8/21 from 7:00 p.m. to 7:00 a.m. LPN Staff G said, Around 8:00 p.m., Resident #66 alerted me that Resident #5 was falling out of her bed. I went to the room and saw Resident #5 off the bed with her head, arm, and shoulder still on the bed. Since she wasn't fully off the bed, I did not consider it a fall. LPN Staff G confirmed Resident #5 was in an unsafe position and unable to get herself back into bed. She said she was unable to assist her alone and called for a CNA to help return Resident #5 back to bed. LPN Staff G said, I work for the agency, but I don't know which CNA assisted me. I don't think it was the CNA assigned to Resident #5. LPN Staff G said, Now that I think about it, I guess it was a fall and I should have reported it. I will in the future. I did not pass on the information to the oncoming nurse the next morning. On 8/11/21 at 1:56 p.m., in an interview Resident #66 confirmed Resident #5 fell out of bed on Sunday (8/8/21) evening and was fully on the floor. Resident #66 said, She waited so long for help hanging off the bed that she slid fully to the floor. On 8/12/21, at 9:45 a.m., in an interview Unit Manager LPN Staff I said, As soon as I heard that there might have been a fall, I went to speak with Resident #66 who told me that Resident #5 had a fall on Sunday (8/8/21) evening. Resident #66 is alert and with it. She knows what is going on. I started an investigation. I spoke to the nurse assigned and the CNA. The Director of Nursing (DON) will determine if it was a fall or not. On 8/12/21, at 11:04 a.m., in an interview the DON said, I heard about the incident but did not consider it a fall after speaking to the nurse assigned. If she had fallen, she would have called her son, and he would have called me. On 8/12/21 review of Resident #5's medical record revealed no documentation of the incident of 8/8/21. On 8/12/21, at 2:00 p.m., the DON and Unit manager LPN Staff I confirmed they did not have any additional nursing documentation regarding the incident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 10 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident and staff interview, the facility failed to maintain a suprapubic catheter in a safe and sanitary manner or notify the physician of symptoms of a suspected urinary tract infection (UTI) for 1(Resident #50) of 1 resident sampled with an indwelling catheter. The findings included: A review of the clinical record for Resident #50 revealed hospital admission on [DATE] through 6/17/21, with a diagnosis of catheter associated urinary tract infection. The record indicated Resident #50 was a paraplegic (paralysis of the lower part of the body). The Clinical record showed a care plan for a suprapubic catheter (catheter inserted through the abdomen into the bladder), with the goal the resident would have no sign or symptoms of a UTI. The interventions were to monitor for signs or symptoms of discomfort and to notify the physician, suprapubic catheter care as ordered, and monitor for pain or discomfort. On 8/9/21 at 9:33 a.m., and 8/10/21 at 2:39 p.m., Resident #50 was observed in his room in bed. The catheter tubing was on the floor. **Photographic Evidence Obtained** On 8/11/21 at 1:16 p.m., in an interview the South Unit Manager, Licensed Practical Nurse (LPN) Staff T said Resident #50 cared for his own suprapubic catheter and would change it himself. LPN Staff T said sometimes the resident would throw it on the floor. On 8/12/21 at 10:02 a.m., during an observation, Resident #50's catheter drainage bag was on the floor and was full of urine. On 8/12/21 at 10:03 a.m., in an interview Resident #50 said he went to the doctor every month to have his suprapubic catheter changed. Resident #50 said, I'm paralyzed from the waist down and I can't move too good. Resident #50 said he did not touch the catheter drainage bag and when the staff emptied it, they hung it back on the bed frame. Resident #50 said he did not put the drainage bag on the floor. Resident #50 said he's had the suprapubic catheter for a long time and has been telling the staff for several days of a burning in his bladder and was certain it was a urinary tract infection. On 8/12/21 at 10:37 a.m., in an interview LPN Staff M said the resident put the drainage bag on the floor. Staff M declined to address the urinary catheter drainage bag stored on the floor and continued to walk down the hall. On 8/12/21 at 11:18 a.m., in an interview, the South Unit Manager LPN Staff T said she was aware Resident #50 has been complaining of bladder pain for a few days and thought he had a urinary tract infection (UTI). Staff T said she had called the physician but was not able to reach him. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 11 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0690 Review of the nursing progress notes for 8/9/21 through 8/12/21 did not show documentation of attempts to contact the Physician regarding Resident #50's report of bladder pain. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 12 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to properly discard expired, over the counter medication in 1 of 2 medication rooms reviewed. This had the potential to administer expired medication to Residents. Additionally, 3 of 3 carts observed in the North and South wings were found with loose pills at the bottoms of the carts. The findings included: The facility policy and procedure, 5.3 Storage and Expiration Dating of Medications, Biologicals, Syringes and Needles, revised [DATE], indicated, (4) Facility should ensure that medications and biologicals that: (1) have and expired date on the label; (2) have been retained longer than recommended by manufacturer or supplier guidelines; or (3) have been contaminated or deteriorated, are stored separate from other medications until destroyed or returned to pharmacy or supplier. Facility should follow manufacturer/supplier guidelines for opened medications. (5.2) Medications with manufacturer's expiration date expressed in month and year (e.g. [for example] [DATE]) will expire the last day of the month. The facility policy and procedure 6.6 Emergency Medication Supplies (Emergency Kits) revised [DATE] indicated, . Facility staff breaking the lock or tamper evident seal on the emergency kit should replace the lock with a tamper-evident lock or seal provided by the pharmacy and located in the emergency kit. On [DATE] at 1:31 p.m., observation of the North Wing medication room with the North Unit Manager Staff I revealed four bottles of Senna-Plus with an expiration date of 5/21; one bottle of Senna-Plus with an expiration date of 4/21; three bottles of Vitamin B6 with an expiration date of 4/21; four bottles of Vitamin B12 with an expiration date of 5/21; three bottles of Vitamin B12 with an expiration of 7/21. The Emergency Drawer Kit (EDK) for insulin was not sealed. The findings were confirmed with North Unit Manager (UM) Staff I. On [DATE] at 3:00 p.m., observation of Medication Cart #3 on North Wing with Licensed Practical Nurse (LPN) Staff W revealed four loose, unidentifiable pills at the bottom of the cart. LPN Staff W acknowledged the findings. On [DATE] at 3:27 p.m., observation of Cart #1 on South Wing with LPN Staff V revealed five loose, unidentifiable pills in the bottom of the cart. LPN Staff V acknowledged the findings. On [DATE] at 3:30 p.m., observation of Cart #1 on the North Wing with Registered Nurse (RN) Staff F revealed six loose, unidentifiable pills in the bottom of the cart. RN Staff F acknowledged the findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 13 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. Based on record review and staff interview, the facility failed to implement policies and procedures to ensure residents and staff were offered the COVID vaccine, educated on the risk and benefits of the vaccine, informed regarding additional dose requirements, and given the opportunity to refuse the COVID-19 vaccine. The findings included: Review of the facility's Policy and Procedure for COVID-19 Vaccine (IC-352) with an effective Date of 8/3/21 noted, 1. COVID-19 vaccinations will be offered to staff and resident (or their representative if they cannot make health care decisions) per CDC [Centers for Disease Control] and/or FDA [Food and Drug Administration] guidelines unless such immunization is medically contraindicated, the individual has already been immunized during this time period or the individual refuses to receive the vaccine. Staff and residents/representatives will be educated on the COVID-19 vaccine they are offered, in a manner they can understand, including information on the benefits and risks consistent with CDC and/or FDA information. This education will at a minimum include the FDA EUA [Emergency Use Authorization] fact sheet for the vaccine(s) being offered until such time that the CDC creates a vaccine information sheet. On 8/11/21 facility infection control record review showed 40 current residents and 55 current employees have declined or not received the COVID-19 vaccination. The facility failed to have documentation the residents and employees were educated on the COVID-19 vaccine, including information on the benefits and risks of the vaccine. On 8/11/21 at 3:25 p.m., in an interview the Director of Nursing (DON) said the facility had not done education to each of the resident or current staff who had declined the COVID-19 vaccination. She said she knew it was to be done and would start implementing the education when offering the next round of vaccine. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 14 of 15 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 106032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Sarasota 1507 S Tuttle Ave Sarasota, FL 34239 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 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and resident and staff interview, the facility failed to ensure a safe, comfortable, and home like environment for 1 (Resident #43) of 2 residents sampled. Residents Affected - Few The findings included: On 8/9/21 at 3:25 p.m., Resident #43 was observed in his room sitting in his wheelchair. The resident pointed to his bathroom and said there were towels on the floor. Resident #43 said the shower pipe has been leaking for several weeks and the staff placed the towels on the floor. On 8/9/21 at 3:30 p.m., observation of the bathroom shower showed a slow, steady leak from the shower handle. The ceiling tile above the door, was partially off, exposing the duct. **Photographic Evidence Obtained** On 8/10/21 at 9:57 a.m., during an observation, the ceiling tile in front of Resident #43's door remained partially off exposing the duct. Wet towels were on the bathroom floor. Resident #43 said the bathroom leak has been going on for over 2 weeks and the staff put the towels there to soak up the water. Resident #43 said he toilets himself and staff placed the towels on the floor to keep him from slipping. On 8/11/21 at 1:23 p.m., in an interview, the Maintenance Director said to repair the leaking pipes in Resident #43's bathroom they would have to turn off the water for the entire facility. The Maintenance Director said he was trying to coordinate a time and day with nursing and dietary staff to turn the water off to fix the leak. On 8/11/21 at 2:00 p.m., in an interview, the Maintenance Director said he was not able to fix the leak in Resident #43's room himself and a plumber was notified but would not be able to repair it for 2 weeks. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 15 of 15