Inspection visit

InspectionOctober 28, 2021

Q: What happened during the October 28, 2021 survey of AVIATA AT BRENTWOOD?

This was a inspection survey of AVIATA AT BRENTWOOD on October 28, 2021. The surveyor cited 5 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Q: Were any deficiencies cited at AVIATA AT BRENTWOOD on October 28, 2021?

Yes, 5 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."

Q: What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

AVIATA AT BRENTWOODCMS #1054615 citations on this visit

5 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 5 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

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 observation, interview, and record review, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice by failing to follow physician ordered parameters for administering medications for 1 of 5 residents, Resident #23, in a total sample of 37 residents. Residents Affected - Few Findings: Review of Resident #23's record revealed the resident was admitted with diagnoses to include diabetes mellitus, chronic kidney disease with dialysis, chronic obstructive pulmonary disease, depression, generalized anxiety disorder and hypotension (low blood pressure). Review of Resident #23's physician order reads, Order Summary: Midodrine HCl Tablet 2.5 MG [milligrams], Give 1 tablet by mouth two times a day related to other hypotension (195.89) Hold for SBP [Systolic Blood Pressure] 115. Order Status: Active. Order Date: 07/21/2021. Start Date: 07/21/2021. Review of Resident #23's electronic medication administration record revealed Midodrine was held per parameters on 10/1/2021 at 5 PM when the blood pressure was documented as 100/62, on 10/8/2021 at 5 PM when the blood pressure was documented as 93/65, on 10/9/2021 at 5 PM when the blood pressure was documented as 110/52, on 10/14/2021 at 5 PM when the blood pressure was documented as 105/69, on 10/20/2021 at 5 PM when the blood pressure was documented as 100/62, on 10/24/2021 at 5 PM when the blood pressure was documented as 104/62, and on 10/26/2021 at 5 PM when the blood pressure was documented as 101/57. During an interview on 10/27/2021 at 4:15 PM, the Director of Nursing (DON) stated, This is not a very good order as it doesn't say to hold the medication for a systolic blood pressure (SBP) above 115, but we know what this medication is for and should not have held the medication when the blood pressure was under 115. We should have gotten an order to clarify the parameters for the medication to be held and we should have administered the Midodrine. We should follow physician orders when we administer medications. On 10/27/2021 at 4:20 PM, during review of the medication administration record with Staff D, Licensed Practical Nurse (LPN), who was the nurse that recorded the medication was held, she verified that the record indicated that the medication Midodrine was held for parameters. Staff D, LPN, stated, Well, the order says to hold it for blood pressure of 115. Oh no, it is Midodrine and that treats hypotension. Well, she sometimes refuses her medication, but I should have administered the medication if the blood pressure was below 115 or documented correctly if she refused the medication. 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 7 Event ID: 105461 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 105461 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Brentwood 2333 N Brentwood Cir Lecanto, FL 34461 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure a resident was offered nutritional supplements as ordered by the physician for 1 of 5 residents reviewed for nutrition, Resident #18, in a total sample of 37 residents. Residents Affected - Few Findings: Review of Resident #18's record revealed the resident had diagnoses to include cerebrovascular accident (stroke), Alzheimer's disease, major depression, anxiety disorder, and hypothyroidism. Review of Resident #18's weights revealed a weight of 112.8 pounds on 4/6/2021 and a weight of 101.4 pounds on 10/5/2021. This is a 10.11% weight loss in 6 months. Review of Resident #18's physician order reads, Order Summary: Magic Amt [amount] ordered PO [by mouth] in add direc [directly] with meals. Order Status: Active. Order Date: 07/09/2021. Start Date: 07/09/2021. Review of the dietary note dated 9/12/2021 by the Registered Dietician (RD) for Resident #18 reads, CBW [Current Body Weight]: 97 lbs, weight loss 6% x 30 days, diet: dysphagia pureed, meal intakes < 50% at times. Weight is stable x 1 week. Supplements in place: fortified foods, Medipass 120 ml TID [three times per day], and magic cup TID recommend increasing med pass 240 ml TID to promote weight maintenance. RD to monitor weight and follow up PRN [as needed]. On 10/25/2021 at 12:12 PM, an observation of Resident #18's meal tray, delivered by Staff G, Certified Nursing Assistant (CNA), showed no magic cup on the tray. Staff G removed the tray from the resident's bedside at 1:06 PM. The resident ate less than 25% of her meal. Staff G did not offer any alternatives and did not offer to assist resident with eating any more of her meal. On 10/26/2021 at 7:30 AM, an observation of Resident #18's meal tray delivered by Staff G, CNA, showed no magic cup on the meal tray. During an interview on 10/26/2021 at 7:50 AM, Staff G, CNA, stated, There is no magic cup on her tray. I don't know if she should have one. On 10/26/2021 at 1:00 PM, an observation of Resident #18 in the common dining area on the unit showed the resident was being supervised during the meal by staff. No magic cup was present on her tray. During an interview on 10/26/2021 at 1:04 PM, Staff H, CNA, verified that the resident did not receive her magic cup with her lunch meal and that it was marked on the resident's menu. Staff H stated, I'm not sure why the kitchen didn't send it. I was in the dining room with her and did not realize that it was not on her tray. I guess I should have checked it. During an interview on 10/26/2021 at 1:29 PM, Staff I, Licensed Practical Nurse (LPN), stated, We should be checking the trays to make sure that the ordered supplements are on them. Usually, the CNA will tell us if there is anything wrong with the meal. During an interview on 10/27/2021 at 9:30 AM, the Director of Nursing (DON) stated, I expect that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105461 If continuation sheet Page 2 of 7 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 105461 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Brentwood 2333 N Brentwood Cir Lecanto, FL 34461 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete staff will check the resident's meal tickets to make sure that the correct meals and supplements are being given to the correct resident. During an interview on 10/27/21 at 12:26 PM, the Registered Dietician stated, There are 890 calories per cup for the magic cups that will aid in maintaining her weights and make sure that she does not lose any further weight. She has had her supplements increased and this has helped her maintain her weight, but not receiving her magic cups will potentially affect her weight negatively. Event ID: Facility ID: 105461 If continuation sheet Page 3 of 7 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 105461 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Brentwood 2333 N Brentwood Cir Lecanto, FL 34461 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 - Some 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the drugs and biologicals used in the facility were labeled and stored in accordance with currently accepted professional principles and included the expiration date when applicable in 4 of 5 medication carts reviewed. Findings: On [DATE] at 8:55 AM, an observation of the medication cart on the 200 Hallway with Staff A, Registered Nurse (RN), showed one opened bottle of Humulin Insulin with no opened and expiration dates and no resident identifier, one opened Lantus insulin pen with no opened date or resident identifier, one opened bottle of Humulin R insulin with an expiration date of [DATE], and one opened bottle of Fluorometholone 0.1% eye drops with no opened or expiration dates. During an interview on [DATE] at 9:09 AM, Staff A, RN, stated, The insulin should be dated and in the pharmacy package, so we know who it is for. The bottle of Humulin R does have an expiration date of [DATE] and that resident isn't here any longer. I don't know why it is still on the cart. It shouldn't be. The eye drops should have the date they were opened or expire. On [DATE] at 9:13 AM, an observation of the medication cart on the 300 Hallway with Staff B, RN, showed one opened bottle of Timolol 0.5% eye drops with no opened or expiration dates, one opened bottle of Alphagan 0.15% eye drops with no opened or expiration dates, one opened bottle of Prednisolone 1% eye drops with no opened or expiration dates, one opened bottle of Timolol 0.5% eye drops with an expiration date of [DATE], and one opened bottle of Novolog Insulin with no opened date or resident identifier. During an interview on [DATE] at 9:18 AM, Staff B, RN, stated, All eye drops, and insulins should have when they were opened and when they expire. The timolol eye drops are expired and should not be on the cart and the insulin should be labeled with who it is for and when it was opened. On [DATE] at 9:19 AM, an observation of the medication cart on the 500 Hallway with Staff C, Licensed Practical Nurse (LPN), showed one opened Lantus flex pen with no opened or expiration dates. During an interview on [DATE] at 9:24 AM, Staff C, LPN, stated, The insulin should have the date it was opened and when it expires. On [DATE] at 9:35 PM, an observation of the medication cart on the 600 Hallway with Staff A, RN, showed two Tresiba Insulin Flex pens with no opened or expiration dates, one opened bottle of Travoprost 0.004% eye drops with no opened or expiration dates, one opened bottle of Gatifloxacin 0.5% eye drops with no opened or expiration dates, and two opened bottles of Prednisolone 1% with no opened or expiration dates. During an interview on [DATE] at 9:45 AM, Staff A, RN, stated, All eye drops should have the date they are opened and when they expire. The insulin pens should have the date they are opened. Review of the facility policy number 5.3 titled Storage and Expiration of Medications, Biologicals, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105461 If continuation sheet Page 4 of 7 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 105461 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Brentwood 2333 N Brentwood Cir Lecanto, FL 34461 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Syringes and Needles with an effective date of [DATE] and an approval date of [DATE] reads, 4. Facility should ensure that medications and biologicals: 4.1 Have an expiration date on the label: 4.2 have not been retained longer than recommended by manufacturer or supplier guidelines. 5. Once any medication or biological package is opened, Facility should follow manufacturers/supplier guidelines with respect to expiration dates for opened medications. Facility staff should record the date opened on the medication container when the medication has a shortened expiration date once opened. 5.1 Facility staff may record the calculated expiration date based on the date opened on the medication container. Event ID: Facility ID: 105461 If continuation sheet Page 5 of 7 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 105461 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Brentwood 2333 N Brentwood Cir Lecanto, FL 34461 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure foods were stored in accordance with professional standards for food service safety. Residents Affected - Many Findings: On 10/25/2021 at 9:20 AM, an observation during a tour of the 300 Hallway nourishment room with the Certified Dietary Manager showed a frozen pink substance pooled in the freezer, an unlabeled/uncovered cup of frozen substance stored in the freezer, and an opened/undated plastic bag of vegetables stored in the refrigerator. During an interview on 10/25/2021 at 9:20 AM, the Certified Dietary Manager confirmed the freezer needed cleaning and the food items should be labeled, dated and covered. On 10/25/2021 at 9:25 AM, an observation during a tour of the 500 Hallway nourishment room with the Certified Dietary Manager showed an opened undated bag of bagels stored in the nourishment room, and a pink substance splattered in the refrigerator. During an interview on 10/25/2021 at 9:25 AM, the Certified Dietary Manager confirmed the refrigerator needed cleaning and food items should be labeled, dated and covered. Review of the facility policy titled Food Storage: Cold Foods last reviewed on 6/30/2021 reads, Procedures: . 5. All foods will be stored wrapped or in covered containers, labeled and dated, and arranged in a manner to prevent cross contamination. Review of the facility policy titled Food: Safe Handling for Foods from Visitors last reviewed on 6/30/2021, reads, Procedures: . 4. When food items are intended for later consumption, the responsible facility staff member will: - Ensure that the food is stored separate or easily distinguishable from the facility food. Ensure that foods are in a sealed container to prevent cross contamination. - Label foods with the resident name and the current date. - Determine if food items are shelf stable and whether they can be stored in the resident room or stored under refrigeration. 5. Refrigerator/freezers for storage of foods brought in by visitors will be properly maintained and: - Equipped with thermometers. - Have temperature monitored daily for refrigeration ? [less than or equal to] 41 ? [degrees Fahrenheit] and freezer ? 0 ?. - Daily monitoring for refrigerated storage duration and discard any food items that have been stored for ? [greater than or equal to] 7 days. (Storage of frozen foods and shelf stable items may be retained for 30 days.) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105461 If continuation sheet Page 6 of 7 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 105461 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Brentwood 2333 N Brentwood Cir Lecanto, FL 34461 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure garbage and refuse were disposed of properly. Residents Affected - Few Findings: On 10/25/2021 at 9:17 AM, an observation during a tour of the garbage disposal area with the Certified Dietary Manager showed two full plastic garbage bags placed on the ground approximately 3 feet from the kitchen area back door. One of the full plastic garbage bags was opened on the side exposing the garbage. One of the two dumpsters was opened on the side. The dumpster was approximately half full of garbage. During an interview on 10/25/2021 beginning at 9:17 AM, the Certified Dietary Manager stated both bags of garbage should be securely closed and should have been disposed of in one of the dumpsters. He confirmed that one of the dumpsters was opened on the side and should have been closed. Review of the facility policy titled Dispose of Garbage and Refuse last reviewed on 6/30/2021 reads, policy Statement: All garbage and refuse will be collected and disposed of in a safe and efficient manner. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105461 If continuation sheet Page 7 of 7

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Citations

5 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0684GeneralS&S Dpotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0692GeneralS&S Dpotential for harm
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
0761GeneralS&S Epotential for harm
F761 - Labeling of Drugs and Biologicals
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.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0814GeneralS&S Dpotential for harm
F814 - Food Safety Requirements
Dispose of garbage and refuse properly.

FAQ · About this visit

Common questions about this visit

What happened during the October 28, 2021 survey of AVIATA AT BRENTWOOD?

This was a inspection survey of AVIATA AT BRENTWOOD on October 28, 2021. The surveyor cited 5 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at AVIATA AT BRENTWOOD on October 28, 2021?

Yes, 5 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

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Data from CMS Care Compare public records. Dataset last refreshed June 8, 2026. If you believe any information is inaccurate, report it here.

Inspection·October 28, 2021