Health inspection·April 24, 2025

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. Based on an interviews, and record reviews, the facility failed to develop and implement a care plan for 1 (Resident #38) of 2 residents reviewed for respiratory care. Residents Affected - Few Findings include: During an observation on 4/21/2025 at 9:48 AM, Resident #38 was lying in raised bed with head of the bed elevated watching television. CPAP device is in a labeled bag on top of dresser close to the wall and back from the bed out of reach of resident on right side of the bed. The Resident is bed bound and cannot move about in bed without assistance. Resident #38 has oxygen administered via nasal cannula at 4 liters per minute. During an interview on 4/21/2025 at 9:48 AM, Resident #38 stated, I have not been receiving CPAP therapy every night because some nurses forget to place the CPAP on me. I will wake up at 2 or 3 in morning and not have CPAP on me. Review of physician's orders on 4/23/2025 at 5:00 PM, Resident #38 did not have any orders for CPAP. During interview on 4/24/2025 at 11:25 AM, the Director of Nursing confirmed the care plan should include the use of a CPAP device for [Resident #38's Name]. Review of policy and procedure titled, Plans of Care, with a review date of 12/18/2024, reads, Policy: An individualized person-centered plan of care will be established by the interdisciplinary team (IDT) with the resident and/or resident representative(s) to the extent practicable and updated in accordance with state and federal regulatory requirements. Plan of care is to be maintained as part of the final medical record. Procedure: Develop a comprehensive plan of care for each resident that includes measurable objectives and timetables to meet the resident's medical, nursing ,mental and psychosocial needs that are identified in the comprehensive assessment. The Individualized Person Centered plan of care may include but is not limited to the following: Resident's strengths and needs, Services to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required by state and federal regulatory requirements, individualized interventions that honor the resident's preferences and promote achievement of the resident's goals. Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 105413 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 105413 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Brooksville 1445 Howell Ave Brooksville, FL 34601 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)