Inspection·November 21, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to prevent the potential spread of infection by not ensuring Enhanced Barrier Precautions (EBP) were followed by not wearing personal protective equipment (PPE) for 1 of 5 residents reviewed for urinary catheter (#3), failed to identify the type of precaution staff needed to follow for EBP for 2 of 5 residents, (#3 and #12) and failed to follow manufacturer's guidelines for cleaning and disinfection of shared glucose meters for 1 of 5 residents reviewed for blood sugar monitoring (#11) of a total sample of 20 residents. Residents Affected - Some Findings: 1. On 11/19/2024 at 9:44 AM, resident #3 was resting in bed. Urinary catheter tubing was noted near the siderail of the resident's bed. Certified Nursing Assistant (CNA) E was in the room at the time and confirmed the resident had a urinary catheter. The resident's room door did not have any signage to indicate type of precautions or the required PPE that staff needed for residents with urinary catheters. On 11/19/2024 at 3:55 PM, resident #3 was observed lying in bed and had indwelling urinary catheter in place. Registered Nurse (RN) C and CNA B were in the room providing care to the resident. CNA B applied ointment to the resident's buttocks. RN C assisted CNA B to apply incontinence brief on the resident then applied moisturizing lotion to the resident's lower legs and feet. Neither CNA B nor RN C wore a PPE gown while they provided high contact care to the resident #3 with an indwelling foley catheter. On 11/19/2024 at approximately 4:50 PM, RN C acknowledged resident #3 did not have identification outside of her room to indicate the type of precautions or the required PPE needed for high-contact care for residents with indwelling catheter. RN C noted the resident had an indwelling urinary catheter and staff should have worn gowns to provide incontinence care. 2. On 11/21/2024 at 12:55 PM, resident #12 was observed sitting up in bed. He stated he had an indwelling urinary catheter. There was no signage outside the resident's room to indicate the type of precautions or the required PPE, and high-contact areas that required use of PPE. On 11/21/2024 at 4:50 PM, RN D verified resident #12 had an indwelling urinary catheter. She stated EBP should be used when providing high contact care. She confirmed there was no signage on the resident's room to alert staff of the type of precautions and PPE needed when providing high contact care to the resident. Review of the policy and procedure effective date: 09/01/2022 read that enhanced barrier precautions (EBP) are used to reduce the spread of multi-drug resistant organisms among residents by utilizing (continued on next page) 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 2 Event ID: 105440 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 105440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Colonial Lakes 15204 W Colonial Dr Winter Garden, FL 34787 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)