Based on observation, interview and record review, the facility failed to provide breakfast meals for 1 of 25 sampled residents on the Windsor Unit (Resident #87).The findings included:Record review showed that Resident #21 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnosis of Dementia and Non-Rheumatic Aortic (valve) Stenosis. The Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the Brief Interview of Mental Status (BIMS) score is 12, which indicates mild cognitive impairment.In an observation conducted on 05/04/26 at 9:50 AM, Resident #87 was seen lying in bed looking at his roommate eating his breakfast. …
F809 citations in Florida
Nutrition and Dietary Deficiencies
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Florida cites F809 less often than its own record predicts
0.86 times the national share — cited less often here than elsewhere.
Of every deficiency written in Florida in 2025, this is the portion that was F809.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Florida surveyors wrote
F809 findings written in Florida, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observations and an interview, the facility failed to ensure that a nourishing snack was served to residents as required when the time lapse between the dinner and the breakfast meals was greater than 14 hours. This was observed for 1 of 1 sampled resident during observations, Resident #121. It had the potential to affect 22 of 24 residents on oral diets in the wing of rooms that included rooms 201A through 212 B. The findings included: Record review revealed Resident #121 was admitted with a diagnosis of Cancer, Anemia, Orthostatic Hypotension, Thyroid Disorder, and Depression. The documented Brief Interview of Mental Status score per Minimum Data Set (MDS) assessment dated [DATE] was 12, indicating moderate cognitive impairment. …
The short window
Recent years
| Year | Share of Florida citations | vs expected |
|---|---|---|
| 2023 | 0.12% | 0.53× |
| 2024 | 0.08% | 0.39× |
| 2025 | 0.16% | 0.86× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Florida surveyors cite →
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