Inspection visit

Health inspectionMay 30, 2023

AVIATA AT THE HARBORCMS #1055494 citations on this visit

4 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 4 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure resident rooms were maintained in a clean, safe and sanitary manner, and failed to ensure Air Conditioning (A/C) units were maintained in a sanitary manner in 10 out of 10 rooms inspected (rooms #132, 125, 117, 114, 214, 218, 222, 220, 205 and 208) in 4 of 4 halls, and did not ensure 2 of 2 rooms had A/C filters in place (rooms #201 and 203). Photographic evidence was obtained. Findings included: During a facility tour on 05/30/23 from 08:23 a.m. to 10:26 a.m., Air Conditioning (A/C) units filters in residents rooms were observed to be layered with a blanket of dirt, debris, and lint on the surface of the filters. The Rooms affected included rooms #132, 125, 117, 114, 214, 218, 222, 220, 205 and 208. rooms [ROOM NUMBERS] were noted without A/C filters and were noted with dirt, debris and lint collecting inside the unit. On 05/30/23 at 9:56 a.m., rooms 214 was observed with stained floors in the bathroom and stains around the toilet base. On 05/30/23 at 10:20 a.m., room [ROOM NUMBER] was observed with a blanket of dust on the resident's nightstand. On 05/30/23 at 10:26 a.m., room [ROOM NUMBER] was observed with missing baseboards. On 05/30/23 at 10:26 a.m., room [ROOM NUMBER] was observed with stained floors in the bathroom and toilet base. On 05/30/23 at 10:30 a.m., an interview was conducted with Staff C, Housekeeping Aide. She stated she did not clean A/C filters because they were not on her list. She stated her responsibility was to wipe the outside of the unit only. She stated she cleans all rooms as assigned and if a room had a maintenance concern, she would report it to her supervisor. On 05/30/23 at 10:38 a.m., an interview was conducted with Staff D, Housekeeping Aide. She stated housekeeping department wipes the outside of the A/C unit, but they do not check filters. She stated the maintenance department was responsible. She stated if a room had any issues, she would notify the housekeeping supervisor. On 05/30/23 at 10:40 a.m., an interview was conducted with the Housekeeping Supervisor. She stated (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 7 Event ID: 105549 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 105549 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Harbor 1410 Dr Martin Luther King Jr St N Safety Harbor, FL 34695 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 0584 they clean all residents rooms daily. Level of Harm - Minimal harm or potential for actual harm On 05/30/23 at 11:00 a.m., an interview was conducted with the Director of Maintenance (DOM). He reviewed surveyor's photographic evidence and said, that does not represent our standards. He stated their goal was to clean the A/C units monthly. He stated he had not gotten around it because he was the only one working in the department. He stated he was doing his best since the assistant was let go. The DOM said, I understand, they need to be cleaned. I will get to them. I prioritize emergencies. I will get them cleaned. Residents Affected - Some On 05/30/23 at 1:10 p.m. an interview was conducted with the Nursing Home Administrator (NHA). He presented a log showing the facility cleans filters every month. He stated they were scheduled to clean the A/C units the following morning. The NHA said, a little lint is expected. Do you clean your filters daily? The NHA was notified that the A/C units revealed a heavy, thick blanket of lint in 4 of 4 wings. He said, We will clean them tomorrow, that's all I can tell you. The NHA restated they had a plan to clean them, and it should not be a problem. He stated they did not have a policy for A/C units maintenance. He stated they follow standard procedures and presented a document titled, Clean air filters. A review of a facility document titled, Clean air filters, dated 5/30/23, showed instructions to remove or open access cover. Remove air filter and inspect for cleanliness. If the filter is dirty, either wash or replace depending on the type of filter. If clean reinstall the filter. Reinstall access cover. Close and make sure it is secure. At a minimum air filters are to be replaced or thoroughly cleaned depending on the type of filter every 3 months. Clean evaporator coils if lint buildup is present. Inspect electrical wires. A review of a facility document titled, Housekeeping in-service, dated 1/1/2000 showed a subject 7-step daily washroom cleaning steps. (5). Clean and sanitize commode - The commode includes the tank, seat bowl and the base. (7) use proper mop and germicide solution to disinfect floors. Be sure to run mop along the edges and never push dirt into corners. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105549 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 105549 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Harbor 1410 Dr Martin Luther King Jr St N Safety Harbor, FL 34695 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and medical record review, the facility did not ensure the medication error rate was below 5 % for two (# 5 and #7) of two sampled residents who were administered medications. This resulted in 7 errors from 28 medication administration opportunities for a medication error rate of 25%. Residents Affected - Few Findings Included: 1. On 05/30/22 at 8:00 a.m. a medication administration observation task was conducted alongside Staff member A, Registered Nurse as he prepared and administered the following medications to Resident #5: Aspirin 325 mg (milligrams), Calcium Carbonate 500 mg 2 tablets, Keppra tablet 1000 mg, Klor-Con tablet 10 meq (millequivalents) 2 tablets, Ascorbic acid 500 mg, Venlafaxine HCL 37.5 mg, Ferrous sulfate 325 mg, Folic acid 1 mg, Senna 8.6 mg, Vitamin D 10 mcg (micrograms), Lamictal 50 mg, Oxcarbazepine 300 mg 2 tablets, Topamax 200 mg, Tegretol XR 12-hour 100 mg, and Percocet oral 7.5 mg -325 mg. Staff A stated, the Prilosec capsule is not available; I only have the tablet. Review of Resident #5 Physician orders revealed calcium carbonate antacid oral tablet chewable 750 mg give 2 tablets by mouth two times a day for supplement dated 08/13/2023 that indicated the wrongs dosage was administered. Prilosec capsule delayed release 20 mg give 20 mg by mouth everyday related to gastroesophageal reflux disease dated 07/08/2021 was omitted. 2. On 05/30/2023 at 9:00 a.m. medication observation was conducted alongside Staff Member B, Licensed Practical Nurse as the following medications were prepared and administered to Resident #7: Amlodipine 5 mg, vitamin B12 500 mcg, Eliquis 5 mg, Fish oil 500 mg, Januvia 100 mg, Labetalol 200 mg, Lamotrigine ER 100 mg, Loratadine 10 mg, Lorazepam 0.5 mg, Methenamine 1 gram, Myrbetriq ER 50 mg, Omeprazole 20 mg, Seroquel 50 mg, and Sodium Chloride 1 gram. Staff B confirmed that was all of Resident #7 medications were provided except for her polyvinyl eye drop that was not available on the medication cart. Medical record review of Resident #7 Physician orders revealed Polyvinyl Alcohol Solution 1.4 % instill 2 drops in both eyes twice daily for dry eyes dated 05/11/2023 was omitted. Further review revealed: -Bisacodyl EC oral tablet delayed release give 100 mg by mouth one a day for constipation dated 05/18/2023 was omitted. -Vitamin D3 super strength oral tablet 50 mcg give 1 tablet by mouth once a day for supplement start date 04/17/2023 was omitted. -Ciprofloxacin HCL Ophthalmic solution 0.3% instill 2 drop in both eyes three times a day (TID) for Pink eyes for 5 days start date 05/26/2023 was omitted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105549 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 105549 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Harbor 1410 Dr Martin Luther King Jr St N Safety Harbor, FL 34695 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few -Insulin Glargine Solution Ten-injector 100 Unit/ml inject 15 unit subcutaneously twice a day related to Type 2 Diabetes Mellitus without complications start date 04/13/2023 was omitted. On 05/30/2023 at 10:20 a.m. an interview was conducted with Staff Member A, he was asked about Resident # 5 calcium carbonate he had administered that reflected a different ordered dosage. Staff A stated, Let me look at it and I'll be right back. Staff A did not return before the survey was concluded. On 05/30/2023 at 11:30 a.m. an interview was conducted with the Director of Nursing related to medication error and omissions. She confirmed medications should be given as ordered. Review of facility Polices and Procedure subject: Medication -Oral Administration Of Revision Date: 922/2017 Procedure: Obtain and verify physician's order. Verify Physician's Order Sheet with Medication Administration Record (MAR) if any uncertainties exist. Compare unit/dose medication on Medication Administration Record (MAR). Read label on the container THREE (3) TIMES: BEFORE REMOVING the drug from the container or card, before returning the drug to the med cart or disposing of the container; and BEFORE HANDLING the drug to the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105549 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 105549 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Harbor 1410 Dr Martin Luther King Jr St N Safety Harbor, FL 34695 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and review of facility policy, the facility did not sure food served to residents was palatable, attractive and at an appetizing temperature for 5 of 5 residents reviewed (#11, #12, #13, #10 and #14). Residents Affected - Some Findings included: On 05/30/23 at 08:52 a.m., an interview was conducted with Resident #10. The resident stated her eggs were cold. She stated this was a problem. She stated she had been at the facility only 3 days, but during the three days her meals were cold. A review of Resident #10's admission record showed the resident was admitted to the facility on [DATE]. A document titled, Admission/readmission Data Collection, dated 05/28/23 showed under cognition Resident #10 was alert, oriented to person, place time and her memory was intact. On 05/30/23 at 08:52 a.m., an interview was conducted with Resident #11. The resident stated she did not eat her breakfast. She stated it was cold, especially her eggs. Resident #11's tray was observed on her bedside table with her meal untouched. A review of Resident #11's admission record showed the resident was admitted to the facility on [DATE]. A Minimum Data Set (MDS) dated [DATE], Section C - Cognitive patterns showed Resident #11 had a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognitive response. On 05/30/23 at 09:40 a.m., an interview was conducted with Resident #12. The resident stated the meals were served cold all the time. He stated he had notified staff. He stated the staff would not warm up his food and he could not understand why. A review of Resident #12's admission record showed the resident was admitted to the facility on [DATE]. An MDS dated [DATE], Section C - Cognitive patterns showed Resident #12 had a BIMS score of 15, indicating intact cognitive response. On 05/30/23 at 09:20 a.m., an interview was conducted with Resident #13. The resident stated he could not eat his breakfast. He stated his breakfast ws cold. He stated his eggs were sold. The resident opened the plate cover and said, No one can eat that. The resident stated the breakfast was served cold. A review of Resident #13's admission record showed the resident was admitted to the facility on [DATE]. An MDS dated [DATE], Section C - Cognitive patterns showed Resident #13 had a BIMS score of 15, indicating intact cognitive response. On 05/30/23 at 10:06 a.m., an interview was conducted with Resident #14. The resident stated her only complaint was related to food temperatures. She stated the food is always served cold. She stated she had told them numerous times. Resident #14 said, They don't use plate warmers. That could help. A review of Resident #14's admission record showed the resident was admitted to the facility on [DATE]. An MDS dated [DATE], Section C - Cognitive patterns showed Resident #14 had a BIMS score of 15, indicating intact cognitive response. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105549 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 105549 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Harbor 1410 Dr Martin Luther King Jr St N Safety Harbor, FL 34695 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 05/30/23 at 08:20 a.m., a tour of the kitchen was conducted. An observation was made of breakfast trays set on the tray line already plated, noted covered ready to be transported to the floor. The plates had eggs and biscuits on them. A test of one of the plates revealed eggs held at a temperature of 100 degrees Fahrenheit. A test of a second plate revealed a temperature of 96 degrees Fahrenheit, both below the required food service temperatures. An immediate interview was conducted with Staff E, Cook. She tested the eggs and confirmed they were cold, and not at the appropriate temperatures. She said, These are cold. We will not serve these plates. She stated she would make sure the trays were at the appropriate temperatures before sending them out. She stated hot foods should be held at a minimum of 140 degrees. A review of the food temperature log for breakfast meal on 05/30/23 showed no documentation to indicate the temperatures had been checked prior to meal service. Staff E confirmed they had already delivered the first breakfast cart. She stated they were waiting to deliver a second one. Staff E stated she should have obtained and documented the temperatures prior to meal service. On 05/30/23 at 11:30 a.m., a second tour of the kitchen was conducted with the Kitchen Manager (KM). He stated he heard residents had been complaining about food temperatures. He stated he thought it was because the facility did not use plate warmers. He said, We will be purchasing plate warmers soon. He stated he would expect residents to be served meals at appropriate temperatures at all times. He stated he would in-service the staff. A review of a facility policy titled, Food- Preparation, dated 09/2017, showed all foods are prepared in accordance with the FDA (Food Drug Administration) food code. The dining services director/cook will be responsible for food preparation techniques which minimizes the amount of time the food items are exposed to temperatures greater than 41 degrees Fahrenheit and less than 135 degrees Fahrenheit or per state regulation. Temperature control for safety (TCS) hot foods will be cooked to a minimum internal temperature for 15 seconds as follows: unpasteurized eggs at145 degrees Fahrenheit. All foods will be held at appropriate temperatures, greater than 135 degrees Fahrenheit (or as state regulation requires) for hot holding. Temperature for TCS foods will be recorded at the time of service and monitored periodically during meal service periods. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105549 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 105549 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at the Harbor 1410 Dr Martin Luther King Jr St N Safety Harbor, FL 34695 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 observations, interviews and facility policy review, the facility did not ensure the kitchen was maintained in a clean, sanitary manner during two of two visits. (Photographic evidence was obtained.) Residents Affected - Some Findings included: A tour of the kitchen was conducted on 05/30/23 between 8:20 a.m. and 8:51 a.m. Two employees were observed without hairnets. Staff G, Dietary Aide did not have a beard hair net and Staff F, Dietary Aide did not have a hair net. They both proceeded to put them on upon surveyor entering the kitchen. Staff F said, I forgot to put on the hair net. I was in a hurry. I normally would have it on. An observation was made of an employee phone placed on a plate on a food prep area. Staff E, [NAME] stated this was her phone. She said, I was listening to music. I should not have placed it there. During the tour it was noted a kitchen light above the dishwashing area loose and hanging downwards. Staff E stated maintenance was aware and they might be repairing it. An observation was made of a tray underneath the food steamer full of brown looking oily liquid mixture. Staff E stated the tray was catching the water that was dripping because the steamer had not been working. She stated this had been going on for a while, but they were using it anyway. During the interview staff E stated some of the kitchen equipment did not work. Staff E said, We had to serve biscuits this morning because the toaster was broken. She stated she did not know how long it was broken or when it would be repaired. An observation was made of flying insects in the appearance of flies, flying around the kitchen, landing on food service areas, including food trays. It was noted that a window in the kitchen was open without a screen, allowing flying insects to get into the kitchen. An interview was conducted with Staff E. She stated it was too hot and that's why they opened the window. She stated she had observed the flies in the kitchen and that she would shoo them away. On 05/30/23 at 11:30 a.m., a second tour of the kitchen was conducted with the Kitchen Manager (KM). He stated there should be no flies on resident's food or any service areas. He stated he would notify maintenance to have a screen installed on the window. During this second tour, the basin underneath the Food Steamer was observed full of water draining from the steamer. The KM stated the equipment had not worked for a couple months. He stated they would clean the dirty water. A review of a facility policy titled, Food- Preparation, dated 09/2017, showed all foods are prepared in accordance with the FDA (Food Drug Administration) food code. Dining services staff will be responsible for food preparation procedures that avoid contamination by potentially harmful physical, biological, and chemical contamination. All utensils, food contact equipment, and food contact surfaces will be cleaned and sanitized after every use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105549 If continuation sheet Page 7 of 7

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Citations

4 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.

0759GeneralS&S Dpotential for harm
F759 - Medication Errors
Ensure medication error rates are not 5 percent or greater.
0812GeneralS&S Epotential 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.
0804GeneralS&S Epotential for harm
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
0584GeneralS&S Epotential for harm
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

FAQ · About this visit

Common questions about this visit

What happened during the May 30, 2023 survey of AVIATA AT THE HARBOR?

This was a inspection survey of AVIATA AT THE HARBOR on May 30, 2023. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at AVIATA AT THE HARBOR on May 30, 2023?

Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure medication error rates are not 5 percent or greater."

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 22, 2026. If you believe any information is inaccurate, report it here.

Health inspection·May 30, 2023