Health inspection·March 23, 2023

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Any changes to advanced directives will require a new Advanced Directive Discussion Document to be completed and placed in the medical record. The previous document to be filed in the thinned record. 1. Resident #45 was admitted to the facility on [DATE] with a history of Traumatic Brain injury, Hypertension, and severe Dementia. The resident is aphasic (unable to speak), and dependent upon staff for mobility, toileting, and personal care. Resident #45 has contractures (deformity and rigidity) of all extremities. Review of Resident #45's weights showed a slow decline in weight from 4/26/22 to 3/3/23. The documentation in the clinical record revealed the resident was unable to make his own medical decision and his spouse was the Health Care Proxy. On 3/21/23 at 4:15 p.m., observation of Resident #45 revealed a growth underneath his upper lip when the resident opened his mouth for oral care and eating. On 3/22/23 at 4:15 p.m. Resident #45's spouse stated no one at the facility had spoken with her regarding what decisions she would make regarding her husbands end of life care. She stated she was no sure if she would want her husband to have a feeding tube to sustain his life. She said she would have to think about it. On 3/22/23 at approximately 4:30 p.m., the Social Service Director stated Resident #45 had a DNR (Do not Resuscitate) in place. The Social Service Director said he was not sure if the resident's spouse would want a feeding tube or mechanical ventilation to sustain the life of the resident. He had not spoken with Resident #45's spouse regarding choices in her husband's end of life care during her last care plan conference and annual comprehensive assessment on 1/20/23. There was currently no documentation regarding the resident's end of life choices. 2. Resident #26 was admitted to the facility on [DATE] with a history of Chronic pain, and renal failure. On 3/21/23 at 2:24 p.m., Resident #26 said since his admission at the facility, no one had asked him about his choices regarding advance directives. The resident said he did not ever want to be placed on mechanical ventilation and would like to initiate a living will. The clinical record lacked documentation of discussion of advance directive for resident #26, including whether the resident wished to formulate an advance directive. On 3/22/23 at 4:20 p.m., the Social Service Director stated on admission he would ask residents for any advance directives they had in place at the time of admission. He said he did not discuss with residents their choice for end-of-life care. He stated he would offer legal documents if residents asked for them. On 3/23/23 at approximately 10:30 a.m., the survey team requested documentation of discussion of advance directive for Resident #26, including whether the resident wished to formulate an advance directive. The Social worker did not supply the requested documentation during survey. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 2 of 18 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 03/23/2023 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of the Resident Assessment Instrument (RAI), staff, and resident representative interviews, the facility failed to ensure the comprehensive assessment accurately reflected the resident's oral status for 1 (Resident #45) of 3 residents sampled for dental services. Residents Affected - Few The findings included: Review of the Resident Assessment Instrument (RAI) manual (Gather information on resident's strength and needs to be addressed in a care plan) version 3.0 revealed poor oral health has a negative impact on quality of life, overall health, nutritional status. Oral mass is a swollen or raised lump, bump, or nodule on any oral surface. May be hard or soft, and with or without pain. The steps for assessment included, Conduct exam of the resident's lips and oral cavity . Visually observe and feel all oral surfaces including lips, gums, tongue, palate, mouth floor, and cheek lining. Check for abnormal mouth tissue . The assessor should use his or her gloved fingers to adequately feel for masses or loose teeth . Review of the clinical record revealed Resident #45 was admitted to the facility on [DATE] with a history of Traumatic Brain injury, Hypertension, and severe Dementia. The resident was aphasic (unable to speak), and dependent upon staff for mobility, toileting, and personal care. Resident #45 has contractures (deformity and rigidity) of all extremities. A nursing progress note dated 7/20/22 at 11:45 a.m. read, contacted [physician] regarding resident wife concern over growth under his upper lip with a small amount of bleeding noted. Awaiting orders, wife aware. A nursing progress note dated 7/27/22 at 2:08 p.m. reads, Appointment made for . ENT [Ear, nose, throat] for growth on upper lip. September 12th at 130 p.m. Review of the Annual Minimum Data Set (MDS) assessment dated [DATE] showed Resident #45 had no mass in his oral cavity. On 3/21/23 at 9:16 a.m., Resident #45's spouse stated he's had a growth under his upper lip for a long time. She said she had told staff about the growth several times . On 3/21/23 at 4:15 p.m., observation of Resident #45 revealed an irregular shaped growth protruding from underneath his upper lip when the resident opened his mouth for oral care and eating. On 3/21/23 at 4:20 p.m., the MDS Coordinator said she did not lift the resident's lip, and did not see the growth when she completed the annual assessment on 1/20/23. On 3/21/23 at 4:40 p.m. the Regional Nurse Consultant said the mass should have been assessed, and documented on the annual comprehensive assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 3 of 18 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 03/23/2023 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 0656 Level of Harm - Minimal harm or potential for actual harm Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Clinical record review revealed Resident #26 was admitted to the facility on [DATE] with a history of chronic pain. Residents Affected - Few Review of the Minimum Data Set (MDS) assessments revealed Resident #26 had an unplanned discharge to an acute care hospital on [DATE] and returned to the facility on [DATE]. On 3/21/23 11:09 a.m., Resident #26 said he had not had a care plan conference since being admitted to the facility. He said the facility changed his pain medications without telling him. On 3/23/23 at 1:40 p.m., the Director of Nursing said Resident #26 had not had a care plan meeting since his admission in November 2022. She said the meeting scheduled for November 2022 did not occur since the resident was hospitalized at the time. She verified the facility had not held a care plan meeting with Resident #26 since his return from the hospital on [DATE]. Based on observation, staff and resident interview and record review the facility failed to ensure residents' participation in care plan for 2 (Resident #4 and #26) of 13 residents reviewed for care planing. The findings included: 1. The facility policy titled Plans of Care, (N-1015) effective 9/25/2017 noted, an individualized person-centered plan of care will be established by the interdisciplinary team (IDT) with the resident and/or resident representatives to the extent practicable and updated in accordance with state and federal regulatory requirements. Clinical record review revealed Resident #4 was admitted on [DATE]. Diagnoses included paraplegia (paralysis of the lower body), and hypertension. The Quarterly Minimum Data Set (MDS) assessment dated [DATE] noted the resident's cognition was intact. On 3/21/23 at 10:41 a.m., Resident #4 was observed in bed. He said he has not had a care plan meeting in quite some time. Resident #4 said being involved in his care was very important and he had a list of things to discuss at the next care plan meeting. On 3/22/23 at 10:26 a.m., Resident #4 said he has a urology appointment in four weeks and he's supposed to follow up with the oncologist this week but didn't know who was coordinating his care. On 3/22/23 at 5:04 p.m., The Social Worker said care plan meetings are held twice a week and are scheduled through the Minimum Data Set (MDS) coordinator. On 3/22/23 at 5:10 p.m., The corporate MDS coordinator said the last care plan meeting for Resident #4 was held on 7/1/2021. She said she was not able to locate any other care plan meeting for Resident #4. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 4 of 18 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 03/23/2023 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review the facility failed to implement an individualized in room activity program to support the physical, mental, and psychosocial well-being of 1 (Resident #45) of 21 residents dependent on staff to meet their needs. Residents Affected - Some The findings included: Clinical record review revealed Resident #45's most recent admission to the facility was 1/19/21 with a history of Traumatic Brain injury, Hypertension, and severe Dementia. The resident was aphasic (unable to speak) and dependent on staff for mobility, toileting, and personal care. Resident #45 has contractures (deformity and rigidity) of all extremities. Resident #45's activity care plan dated 5/21/19 noted the resident was dependent on staff in meeting emotional, intellectual, and social needs related to daily leisure as evidenced by cognitive deficits. The care plan noted the resident needed bedside/in-room visits and activities if unable to attend out of room events. On 3/20/23 at 11:11 a.m., and 3:40 p.m., 3/21/23 at 9:35 a.m., and 4:10 p.m., Resident #45 was observed in bed. The resident was aphasic and not responsive to verbal stimuli. The television was not on and there was no radio in the resident's room. On 3/22/23 at 9:30 a.m. the Activities Director verified Resident #45 did not get out of bed very often. She said the resident's wife visits several times a week. The Activities Director verified Resident #45 was care planed for in room visits and they should be documented in an electronic progress notes. After reviewing the electronic clinical record with the Activities Director, she verified the last documented one-to-one activity for Resident #45 was dated 10/21/22. On 3/22/23 at 10:33 a.m., Resident #45's wife said she has not seen any staff members providing one-to-one activities with her husband. She said her husband was a minister and he loved gospel music. On 3/22/23 at 11:15 a.m., the Regional Nurse Consultant provided a list of 21 residents which she said were dependent on staff for one-to-one activities. She said she could not locate documentation of one-to-one visits for the 21 residents listed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 5 of 18 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 03/23/2023 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on record review and staff interview, the facility failed to coordinate care and services and obtain timely necessary appointment with an outside specialist for 1 (Resident #26) of 6 residents reviewed for compliance with physician's order. Residents Affected - Few The findings included: On 3/23/23, clinical record review for Resident #26 revealed a physician's order dated 1/9/23 for a nephrology (kidney) referral for a diagnosis of stage 3, nearly 4 renal failure, and an order for a neurology referral dated 1/10/23 for a diagnosis of chronic daily headaches with ringing in the ears and head. The clinical record lacked documentation the facility followed through and obtained the necessary nephrology, and neurology appointments for the resident. On 3/23/23 at 9:00 a.m., the Director of Nursing verified the facility had not scheduled the appointments as per the physician's orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 6 of 18 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 03/23/2023 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 - Few 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. Based on observation, record review, staff and resident interviews, the facility failed to implement processes to identify and ensure the proper storage of medications at residents' bedside for 3 (#67, #98 and #101) of 3 residents observed with unsecured medications at the bedside. The findings included: Review of facility policy titled Storage and Expiration dating of Medications, Biologicals effective 12/1/07 with the last revision date of 7/21/22 states under General Storage Procedures, the facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors. Under Bedside Medication Storage heading the policy states facility should not administer/provide medications or biologicals without a Physician/Prescriber order and approval by the interdisciplinary care team and facility administration; facility should store bedside medication or biologicals in a locked compartment within the resident's room; facility should ensure that only facility representatives and the appropriate resident maintains the keys, access cards, electronic codes, or combinations which open the locked compartment. 1. On 3/20/23 at 10:06 a.m., Resident #98 was observed having Nicotine gum stored on a dresser in his room. He said he has been chewing it for about a month. He said, all the staff know I have it. Medical record review for Resident #98 reveals no Physician order for Nicotine gum and no assessment with approval for self-administration of medications. 2. On 3/20/23 at 10:28 a.m., Resident #101 had a bottle of eye vitamins stored on the bedside table. He said he had been taking them for the past two months. Photographic evidence obtained 3. On 3/20/23 at 12:28 p.m., Resident #67 had a bottle of vitamins and a tub of pain relief cream stored on the bedside table. He said he takes the vitamins daily and uses the pain relief cream on his leg. He said his wife brought the medications. Photographic evidence obtained On 3/22/23 at 3:54 p.m., Registered Nurse (RN) Staff G Unit Manager verified the unsecured medications at Resident #67's bedside. She said she was unaware the resident had medications at the bedside, and staff should have identified them. On 3/23/23 at 1:35 p.m., Certified Nursing Assistant (CNA) Staff I said she was not aware Residents #98 and #101 had medications at the bedside. She said she was from a staffing agency and had not received any in-service training at the facility related to unsecured medications stored at the bedside. On 3/23/23 at 11:36 a.m., the Director of Nursing (DON) said no current residents have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 7 of 18 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 03/23/2023 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 authorization to store medications at the bedside. Level of Harm - Minimal harm or potential for actual harm On 3/23/23 at 1:43 p.m., RN Staff J said she was from a staffing agency and had not receive any education related to self administration of medications or medications stored at the bedside. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 8 of 18 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 03/23/2023 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 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. Based on observation, review of facility policy, and procedures, resident and staff interviews, the facility failed to ensure menus were developed and prepared to meet resident choices, and nutritional needs. The facility failed to identify and document resident preferences and respond to them. The findings included: Facility policy JCSG Policy 005, revised 9/2017, titled Dining and Food Preferences, was obtained. The policy stated individual dining, food, and beverage preferences are identified for all residents/patients. The Dining Services Director or designee will interview the resident or representative to complete a food preference interview. The purpose of identifying individual preferences is for dining location, meal times, including meal times outside of the routine schedule, and food and beverage preferences. The food preference interview will be entered into the medical record. The Registered Dietitian or other clinically qualified nutrition professional will review and, after consultation with the resident, will enter information pertinent to the individual meal plan into the plan of care. The individual tray ticket will identify all food items appropriate for the resident based on diet order, allergies, intolerances, and preferences. On 3/21/23 at 11:26 a.m., during a group interview, Residents #39, #54, #6, #23, #18, #40, #14, #60, #57, and #1 said the dietary staff would leave a tray of snacks at each nursing station prior to closing the kitchen each day to be given to the diabetic residents at night. The residents said when they asked the night shift staff the facility only provided snacks for diabetic residents at night. They said there was no snack available at night for non-diabetics. The night shift staff told them they could only have left over snacks from the diabetic snacks. Review of the food committee meeting minutes from September 2022 through February 2023 showed residents repeatedly reported concerns about food quality, temperature, and lack of choices. Comments included, Residents hoped to see more choices of protein, more variety, and sandwiches at night, We are tired of pork and turkey, the sausage needed to be cooked more, we want yogurt added to the menu, the toast is served hard, the food is served cold, and the chicken is dry, we want bananas. During the February meeting, the residents again complained of cold food and the trays sitting in the hallway waiting to be passed for a long time. The resident council meeting on 2/1/23 noted a food committee meeting was scheduled for residents, who stated they have numerous concerns. The resident council meeting on 3/1/23 noted a dietary staff stopped briefly for an introduction and informed the council that he was addressing food and dietary concerns. On 3/21/23 at 1:15 p.m., the Registered Dietitian (RD) stated she reviewed and approved the facility menus on 1/31/23. She stated the menus are prepared by corporate, and she would prefer to see more protein and fresh items. She stated 100% pure fruit juice is offered at each meal and is counted as the fruit option. She confirmed no low-sugar or sugar-free juices or snacks for the diabetic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 9 of 18 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 03/23/2023 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 0800 residents were available. Level of Harm - Minimal harm or potential for actual harm On 3/22/23 at 12:00 p.m., the delivery of lunch trays pass on the 100 hall was observed with the Dietary Manager. Lemonade was served to all residents. The dietary manager stated the beverage preferences were listed on the meal ticket. Residents Affected - Some Review of random meal tickets with the manager confirmed no beverage preferences were listed, and no residents on the 100 hall were offered a choice of beverage. On 3/22/23 at 2:10 p.m., a follow-up interview was conducted with the dietary manager and the regional district food manager. The dietary manager stated she had been in this position for a week. She reviewed the dietary committee minutes yesterday. The menu comes from corporate, and she does not have any control over that. Yogurt is available if residents ask for it. She said she did not have documentation of meetings with residents or their preferences. She said they generally don't get fruit. Residents can pick an alternative before the meal cut off time. The regional manager confirmed salad was not available as an alternate. Alternates were only available for lunch and dinner, not breakfast. He agreed the juices as currently served are not 100% pure juice and are not an equal substitution for a fruit serving. On 3/23/23 at 10:10 a.m., Certified Nursing Assistant (CNA) Staff K, she said the kitchen staff delivered a snack tray to each nursing station before closing the kitchen for the night. The snack trays contained snacks for diabetic residents and a few extra snacks on the tray. She said there were never enough snacks to give to all the residents who requested a snack before the dietary staff left. On 3/23/23 at 11:07 a.m., the RD stated one fruit serving would be the equivalent of eight ounces of 100% juice, and there were 30 diabetic residents in the building. The regional food service director present during the interview stated juice is offered at all three meals. He confirmed if residents requested juice, they were served juice in a 6-ounce cup that was half full, providing 3 ounces of juice, which is less than half of a fruit serving. Residents were unaware they needed to request juice or that it was available. The RD confirmed all residents were getting the same juice with sugar without regard to diet orders. The RD stated that diabetic residents should only have sugar-free juices, which she had not seen here. The juice was approved as a fruit serving. Residents should be offered choices of beverage. The RD confirmed only lemonade (not sugar-free) was available on the beverage cart on the north hall. The RD stated there were not enough beverages on the cart to serve all the residents. On 3/23/23 at 10:18 a.m., Resident #1 stated, no one has met with me regarding food choices or preferences. I would really like it if someone did. I like fruit and salad. We hardly ever get fruit. They only have vinegar and oil dressing. The old dining manager would make sure we had French dressing. I liked that a lot. On 3/23/23 at 10:28 a.m., Licensed Practical Nurse (LPN), Staff A, stated many residents have said there is not enough food, and they don't like the food. All she can do is pass it on to the dietary manager. On 3/23/23 at 12:12 p.m., The 500-hall meal delivery was observed. Each resident received lemonade and coffee. The residents were not offered a choice of beverage. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 10 of 18 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 03/23/2023 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 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete On 3/23/23 at 2:14 p.m., the administrator stated he was aware of the resident food concerns and was trying to address them. On 3/23/23 at 3:58 p.m., the Director of Nursing (DON) stated the facility should be offering sugar-free pudding and a good protein snack at night. Sugar-free snacks should be available to those that have diabetes. Diabetic residents should not drink juice, period. We give snacks at 10:00 a.m. and 2:00 p.m., and a bedtime snack is provided. Snacks should be offered to everyone. The minimum expectation is for the CNA to take the snacks and pass them out immediately when they arrive on the unit. Event ID: Facility ID: 106032 If continuation sheet Page 11 of 18 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 03/23/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, record review, and interview, the facility failed to store food in accordance with professional standards for food service safety. The facility also failed to ensure regular cleaning of ice machines to prevent buildup of dust and bio growth. This had the potential to affect all 113 residents who reside in the facility and consume an oral diet. The finding included: The facility policy titled Food Storage stated all time/temperature control for safety (TCS) foods, frozen and refrigerated, will be appropriately stored in accordance with guidelines of the FDA Food Code. All foods will be labeled, dated, and arranged in a manner to prevent cross-contamination. The facility policy titled Snacks revised 9/2017, stated all snacks will be properly stored for time and temperature control, as appropriate. The Food and Drug Administration guide, effective March 2017, stated, Never thaw food at room temperature, such as on the countertop. On 3/20/23 at 9:17 a.m., during the initial kitchen tour, a bag of fish was observed open defrosting on the prep table at room temperature. Dietary Staff person D confirmed food is not to be defrosted at room temperature. Photographic evidence obtained A half-full pitcher of red juice was observed in the walk-in refrigerator. The pitcher was not labeled or dated. Dietary Staff D said the pitcher contained tomato juice and should have been dated. On 3/22/23 at 3:34 p.m., water was observed dripping over large amount of black and grey bio-growth covering the sides and back of the ice maker in the main kitchen. The maintenance director confirmed the observation and said the ice machines are cleaned monthly. He said the ice machine was last cleaned on 3/4/23. Photographic evidence obtained On 3/22/23 at 3:38 p.m., A snack tray containing pudding and peanut butter and jelly sandwiches was observed sitting on the counter of the north hall pantry. The maintenance director commented the room air temperature was about 80 degrees. Photographic evidence obtained On 3/22/23 at 4:10 p.m., The regional food service director said the snack tray with the pudding was delivered to the north nursing station just before 2:00 p.m. He said the pudding needed to be refrigerated. Nursing should have served the pudding to the residents or put the pudding in the refrigerator. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 12 of 18 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 03/23/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm On 3/22/23 at 3:39 p.m., the north hall ice maker was observed with the maintenance director. The Ice in the bin was discolored, and a black object was noted in the ice. The Maintenance director said he did not know what the object was. The internal wires were covered with dust; the internal components had a large amount of corrosion and debris. Residents Affected - Many Photographic evidence obtained On 3/23/23 at 3:58 p.m., The Director of Nursing stated, We pass snacks at 10:00 a.m. and 2:00 p.m. The minimal expectation is for the certified nursing assistant to take the snacks and pass them out immediately. The snacks should not sit in the pantry for one to two hours. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 13 of 18 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 03/23/2023 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to implement effective corrective actions for deficiencies identified on the recertification survey completed on 3/23/23. The findings included: 1. On 5/9/23, review of the recertification survey completed 3/23/23 revealed Resident #45 had a mass in his oral cavity that was identified as early as 7/20/22. The annual MDS with an assessment reference date of 1/20/23 incorrectly noted there was no mass in the oral cavity of Resident #45. Further review revealed no evidence the annual MDS for Resident #45 had been modified to correct the deficiency. 2. On 5/9/23, review of the recertification survey completed 3/23/23 revealed Resident #26 had not had a care plan conference since being admitted to the facility on [DATE]. On 5/8/23 at approximately 9: 30 a.m. Resident #26 said he has still not had a care plan conference. Record review of Resident #26 revealed no evidence a care plan conference had occurred with Resident #26. 3. On 5/9/23, review of the recertification survey completed on 5/9/23 revealed the facility failed to administer the annual influenza vaccine to Resident #412. The facility was to re-educate licensed nurses on the components of the regulation with an emphasis on ensuring residents are offered and if consented receive the requested vaccine. On 5/9/23, record review of Resident #500 revealed a consent signed by Resident #500 on 4/21/23 to receive the pneumococcal vaccine. An order was written on 4/24/23 for administration of the vaccine. Further review revealed the vaccine was not administered until 5/8/23 after surveyor's request for documentation the resident received the pneumococcal vaccination as requested. On 5/9/23 at approximately 2:00 p.m., the facility Director of Nursing said a nurse was supposed to administer the vaccine on 4/24/23 but did not and somehow the order dropped off. She said after surveyor inquiry about the vaccine, the facility noted the vaccine had not been given and another order was written on 5/8/23 to administer the vaccine. 4. On 5/9/23, review of the recertification survey completed on 3/23/23 revealed A half-full pitcher of red juice was observed in the walk-in refrigerator. The pitcher was not labeled or dated. On 5/9/23 at approximately 9:30 a.m., during a tour of the kitchen with the kitchen manager, two opened gallon jugs of mile were observed in the walk-in cooler. There was no date opened on the jugs of milk. On 5/9/23 at approximately 2:30 p.m. the Administrator confirmed the facility had failed to implement and monitor corrective actions for deficiencies identified on the recertification survey (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 14 of 18 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 03/23/2023 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 0867 completed on 3/23/23. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 15 of 18 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 03/23/2023 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to administer the annual influenza vaccine to 1 (Resident #412) 5 residents reviewed for immunization. Residents Affected - Few The findings included: Review of the facility policy for Influenza vaccine revised March 2022, between October 1st and March 31st each year, the influenza vaccine shall be offered to residents ., unless the vaccine is medically contraindicated or the resident .has already been immunized. Review of the admission Record for Resident #412 revealed the resident was admitted to the facility on [DATE] and was his own responsible health care decision maker. Resident #412's diagnoses included seizures, obesity, arthritis, colostomy, knee pain, and muscle weakness. On 3/21/23 at 4:50 p.m., Resident #412 said he was admitted a few weeks ago and signed the consent for the influenza vaccine. The resident said the facility has not given the flu vaccine yet and he is wondering what is going on. Review of Resident #412's Influenza Vaccine Consent form revealed Resident #412 gave the facility permission to administer the Influenza vaccine on 3/9/23. Review of Resident #412's Medication Administration Record (MAR) for March 2023 revealed the facility did not vaccinate Resident #412 for the flu, as the resident had consented. On 3/23/23 at 12:00 p.m., the Unit Manager said the admitting nurse obtains the consent for the influenza vaccine when the resident is admitted . The chart is reviewed, and the vaccine is given to residents who want it. On 3/23/23 at 12:10 p.m., the Assisted Director of Nursing (ADON) confirmed Resident #412 signed the flu consent on 3/9/23. The ADON confirmed there were no contraindications for Resident #412 to receive the influenza vaccine and the resident had not received the annual dose previously. The ADON confirmed the facility had not given the flu vaccine to Resident #412. The ADON verified Resident #412 should have received the flu vaccine already but did not. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 16 of 18 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 03/23/2023 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 - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to administer the COVID-19 vaccine to 1 (Resident #412) of 5 residents reviewed for COVID-19 immunization. The findings included: Review of the facility policy COVID-19 Vaccine - Resident with a revision date of 11/17/21: 1. COVID-19 vaccinations will be offered to residents .unless such immunization is medically contraindicated, the individual has already been immunized during this time period, or the individual refuses to receive the vaccine. 3. a. In case of lack of availability of the COVID-19 vaccine or other issue with he availability leading to an inability to implement the COvID-19 vaccine program, the center will document the attempts to order vaccines .including Long Term Care (LTC) pharmacies and the state health department. Review of the admission Record for Resident #412 revealed the resident was admitted to the facility on [DATE] and was his own responsible health care decision maker. Resident #412's diagnoses included seizures, obesity, arthritis, colostomy, knee pain, and muscle weakness. On 3/21/23 at 4:50 p.m., Resident #412 said he was admitted a few weeks ago, signed the consent for the COVID-19 vaccine and has not received it yet. Review of Resident #412's COVID-19 Vaccine Consent form revealed Resident #412 gave the facility permission to administer the vaccine on 3/9/23. The consent form revealed Resident #412 had not received a previous dose of the vaccine and did not have any risk factors that would prohibit getting the COVID-19 vaccine. Review of Resident #412's Medication Administration Record for March 2023 revealed the facility had not administered COVID-19 vaccine to Resident #412. On 3/23/23 at 12:00 p.m., the Unit Manager said the admitting nurse obtains the consents for the COVID-19 vaccine when the resident is admitted . The chart is reviewed, and the vaccine is given to the residents who want it. On 3/23/23 at 12:10 p.m., the Assisted Director of Nursing (ADON) confirmed Resident #412 signed the COVID-19 consent on 3/9/23. The ADON confirmed there were no contraindications for Resident #412 to receive the vaccine and the resident had not received it previously. The ADON confirmed Resident #412 should have received the COVID-19 vaccine but did not. On 3/23/23 03:30 p.m., the Director of Nursing (DON) said the COVID-19 vaccine consent is obtained (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106032 If continuation sheet Page 17 of 18 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 03/23/2023 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 and they order the vaccine within 3-5 days. The resident would get vaccinated within a week. 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 18 of 18