Inspection·August 1, 2023

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities 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, and interview, the facility failed to refer for a Preadmission Screening and Resident Review Process (PASSR) Level II screening for 1 resident (#1) of 3 residents reviewed for mental illness. A PASRR Level II is required for individuals with mental disorders and intellectual disabilities to ensure proper placement in the nursing home and obtain additional services for the resident while in the nursing home. Residents Affected - Few The findings included: Review of the facility Policy for PASRR dated 11/8/21: The center will assure all Serious Mentally Ill (SMI) and Intellectually Disabled (ID) residents receive appropriate pre-admission screenings according to Federal/State guidelines. The purpose is to ensure the residents with SMI or are ID receive the care and services they need in the most appropriate setting. Review of Resident #1's Preadmission Screening Inclusionary and Exclusionary Checklist dated 9/26/07 revealed diagnoses included Anoxic Brain Damage and Recurring Depression. Resident #1 was admitted to the facility on [DATE] and did not have a PASRR Level II in the medical chart. Review of the psychiatrist's note dated 6/12/23 revealed Resident #1 was [AGE] years old and admitted to the facility on [DATE]. The resident was being re-evaluated at the request of the facility because she was found outside of the building, crying, stating, I want to go away from this place. The psychiatrist noted Resident #1's past medical history included Major Depression, Mental Disorder, and Psychosis. On 7/31/23 at 12:50 p.m., the Licensed Clinical Social Worker (LCSW) said she meets with Resident #1 twice a month for psychotherapy. She said Resident #1 was child-like, wants her stuffed animals, and never learned to read, or write. She said Resident #1 always lived with her mother until she passed away. Now Resident #1 has a state appointed guardian. The LCSW said she believes Resident #1 is mentally retarded/developmentally delayed (MRDD). She said she tried to get her into a program but all her money goes to the facility. On 7/31/23 at 1:21 p.m., Resident #1 said she is not happy living at the facility. The resident became visibly upset and started to cry. She said she wants to go back to school and learn to read and write but the facility can't afford it. On 7/31/23 at 3:01 p.m., the Social Services Director (SSD) said she is familiar with Resident #1, and the resident has lived at the facility since 2007. She said Resident #1 has Encephalopathy and Mental Illness/Mental Retardation. She confirmed Resident #1 had gone to a program in the past, but (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: 105443 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 105443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Venice 1026 Albee Farm Rd Venice, FL 34285 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)