Health inspection·February 27, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview, and record review the facility failed provide appropriate interventions to prevent falls for 2 (Residents #1, and #2) of 3 residents surveyed with a history of falls with major injury. Failure to provide appropriate fall interventions creates a potential for falls and fall related injuries to the residents. The findings included: The facility policy on Fall Management Document N-1259 effective 11/30/14 and last revised 7/29/19 reads, Residents are evaluated for fall risk. Patient Centered interventions are initiated, based on resident risk . Purpose: Is to identify residents at risk for falls and establish/modify interventions to decrease the risk of future falls and minimize the potential for resulting injury. Clinical record review revealed Resident #1 was admitted to the facility on [DATE]. Diagnoses included Metabolic Encephalopathy, Osteoarthritis, Bradycardia (heart rate below 60 beats per minute) and Idiopathic Hypotension. Review of the care plan initiated on 4/1/24 revealed Resident #1 was at risk for recurrent falls and falls related injuries related to gait/balance problems, incontinence, poor communication, comprehension, unaware of safety needs, hearing problems and a history of falls. On 6/26/24 the facility updated the care plan showing Resident #1 had an actual fall, refusing hipsters (briefs with impact absorbing padding over hips areas). Review of the Quarterly Minimum Data Set (MDS) Assessment with a target date of 7/8/24 noted the resident's cognition was severely impaired with a Brief Interview for Mental Status score of 04. Resident #1 required partial/moderate assistance with transferring, did not exhibit behaviors or refuse care. Review of facility's incident investigations revealed on 7/8/24, Resident #1 sustained an unwitnessed fall. X-rays obtained at a local hospital were negative for fracture. Resident #1 complained of pain on and off to the left hip and thigh after the fall. On 7/12/24, a new X-ray showed a questionable fracture of the left femur. Resident #1 was transferred to a local hospital and underwent a surgical repair of the fracture. The facility's investigation showed on 7/8/24 staff did not ensure Resident #1 was wearing the hipsters as per the care plan. (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 3 Event ID: 105588 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 105588 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Santa Barbara 216 Santa Barbara Blvd Cape Coral, FL 33991 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)