Health inspection·August 6, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the evening shift (2:00 p.m., to 10:00 p.m.).On 6/13/25, 6/17/25, and 7/7/25, during the night shift (10:00 p.m., to 6:00 a.m.). There was no documentation in the clinical record the Practitioner was informed Resident #1 had large loose stools.On 8/4/25 at 1:22 p.m., in an interview LPN Staff A said he recalled talking with Resident #1's brother. He said Resident #1 had a lot of fluid in her legs and was on diuretics (medication to help urinate excess fluid). LPN Staff A said, according to the charting, the five days before she was sent to the hospital, Resident #1 had mixed stools, some formed and some loose. He went over the resident's medications with the brother. He said she did not recall anyone telling him they found Resident #1 in diarrhea. The resident's labs indicated she had a urinary tract infection. He talked with the family about getting checked out. Basically, he explained to them what was happening with the resident and what the facility was doing to treat it. He said the scheduled Morphine (pain medication) was causing the slurred speech and they stopped it.On 8/5/25 at 9:23 a.m., in a telephone interview, Resident #1's brother said at the beginning of July 2025 he was on the phone with his sister (Resident #1). She was mumbling, crying, trying to talk, she just couldn't talk. He said he was concerned and flew down to see her. He said several times when he visited, he found her soiled, a mess, diarrhea on the bed. She was having difficulty speaking clearly. He asked his cousin to come to the facility. On Monday 7/7/25, he and his cousin spoke with Licensed Practical Nurse (LPN) Staff A about their concerns related to Resident #1's mentation, medications, finding her in soiled diapers multiple times. They were concerned Resident #1would end up with a urinary tract infection and go septic. They requested to have Resident #1 sent to the hospital to be examined. LPN Staff A told them they were adjusting Resident #1's medications and there was nothing they could do at the hospital that they couldn't do at the facility. He said he returned home and within 24 hours, he received a call from the hospital informing him Resident #1 was sent to the emergency room on 7/8/25 and was admitted to the Intensive Care Unit with a diagnosis of septic shock and C-diff.On 8/5/25 at 9:47 a.m., in an interview LPN Staff A said when Resident #1's brother showed up he spoke with him about pharmacology and fluid. Staff A said he went through labs at the time. They spoke about the scheduled morphine. Resident #1 said she felt off and it was visually apparent. Her speech was off, her posture was affected. It was difficult for her to sit up, it seemed like she was drugged. LPN Staff A said they reached out to pain management and the morphine was discontinued.On 8/5/25 at 10:03 a.m., in a telephone interview the APRN said sometimes the ordered labs are not done. Sometimes the residents refuse. The APRN said if the labs had been drawn and resulted in critical levels, he would have sent Resident #1 to the hospital. The APRN said no one told him the resident was experiencing loose stools.On 8/5/25 at 3:23 p.m., in an interview the Assistant Director of Nursing (ADON), Registered Nurse (RN) Staff B said on 7/7/25 he spoke with Resident #1's brother and one other person. He said Resident #1 had confusion, bipolar and pain. He spoke with the family about bipolar disease and that Resident #1 could be cycling, making her more confused. He said the family did not complain to him about Resident #1 having loose or foul smelling stools or diarrhea. They did not say anything about concern of a urinary tract infection or sepsis. He talked to them about trying to assist Resident #1 to the bathroom with a Certified Nursing Assistant but Resident #1 couldn't do it because she was too weak. ADON, RN Staff B said he did not document the concerns the family brought to his attention.Record review of Resident #1's clinical record and grievance log revealed no documentation of the concerns expressed by Resident #1's family members on 7/7/25.On 8/6/25 at 11:07 a.m., in an interview the Administrator said they looked through Resident #1's clinical record and didn't find any lack of services. They did not catch that the lab was missed. The Administrator said, I would think there would be a nursing note to address the cause of the resident's confusion. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105588 If continuation sheet Page 2 of 5 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 08/06/2025 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)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete There were some medication changes, but review of the chart showed no progress note of contacting the doctor or what the concerns were.Resident #2:Review of Resident #2's clinical record on 8/6/25 revealed a practitioner's order for blood work dated 7/24/25 for CBC, Comprehensive Panel and a Hemoglobin A1C. The lab collected blood work on 7/25/25, but not the Hemoglobin A1C. On 8/5/25 a new order was placed for the Hemoglobin A1C. Resident #3:On 8/6/25, review of Resident #3's clinical record revealed a practitioner's order for blood work dated 8/4/25. On 8/5/25, a progress note noted the labs were not drawn. The APRN was notified and the labs were reordered and rescheduled to be drawn on 8/6/25.On 8/6/25 at 11:41 p.m., in an interview the Regional Nurse said on 8/4/25 when they became aware of the missed blood work for Resident #1, they audited the clinical records for missed labs from 7/5/25 through 8/5/25. During the audits, they identified 13 other residents with missing labs, including Residents #2 and #3. Event ID: Facility ID: 105588 If continuation sheet Page 3 of 5 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 08/06/2025 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)

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility staff failed to follow processes to ensure laboratory testing were done as ordered to meet the needs of 3 (Residents #1, #2 and #3) of 3 residents reviewed.The findings included:Review of the facility's policy and procedure titled, Laboratory, Diagnostic and X-Ray with a revision date of 02/02/2024 revealed, Procedure: Obtain a physician's order for laboratory work, diagnostic testing, and x-ray. Complete the required requisition form(s). Schedule laboratory work, diagnostic test and or x-ray as indicated.Review of the clinical record for Resident #1 revealed an admission date of 6/12/25.Review of the progress notes revealed on 7/5/25 the Advanced Practice Registered Nurse (APRN) documented Resident #1 was evaluated for persistent bilateral leg edema (swelling) and shortness of breath. The practitioner documented a CMP (Complete metabolic panel) and Pro-BNP (measures a specific protein) were ordered to monitor electrolytes and volume status. The plan of care was discussed with the nurse. The progress note documented next labs pending were comprehensive panel, CBC (complete blood count) and Pro-BNP.Review of the Treatment Administration Record (TAR) for July 2025 revealed on 7/7/25, the Licensed Nurse placed her initials, indicating Resident #1's blood was drawn for the CMP, CBC and Pro-BNP.On 7/8/25 the APRN documented in a progress note Resident #1 complained of dysuria (painful urination). A urinalysis revealed a urinary tract infection. The APRN documented the laboratory tests were currently pending results to monitor kidney function and electrolytes. On 8/4/25 review of the clinical record for Resident #1 failed to reveal results for the CBC, BMP and Pro-BNP the licensed nurse signed as obtained on 7/7/25.On 8/4/25 at 2:50 p.m., in an interview the Director of Nursing (DON) and Regional Nurse verified the lack of results for the CBC, BMP and Pro-BNP the APRN ordered on 7/5/25. They said they were not aware the resident's blood was never drawn.Review of Resident #2's clinical record on 8/6/25 revealed a practitioner's order for blood work dated 7/24/25 for CBC, Comprehensive Panel and a Hemoglobin A1C. The lab collected blood work on 7/25/25, but not the Hemoglobin A1C. On 8/5/25 a new order was placed for the Hemoglobin A1C. On 8/6/25, review of Resident #3's clinical record revealed a practitioner's order for blood work dated 8/4/25. On 8/5/25, a progress note noted the labs were not drawn. The APRN was notified and the labs were reordered and rescheduled to be drawn on 8/6/25.On 8/6/25 at 10:55 a.m., in an interview the DON said the laboratory is integrated in the facility's electronic clinical record. When a laboratory order is entered in the electronic clinical record, it goes directly to the lab and is automatically transcribed on the TAR. She said the practitioners and licensed nurses who enter lab orders in the electronic clinical records were responsible to print the laboratory requisition and place it in the laboratory binder at the nurse's station. She said the laboratory technician uses the printed laboratory requisition to obtain the residents' specimen.She said the binder also contains a laboratory log where the laboratory technician signs off on the specimen obtained. She said, the licensed nurses or the lab technicians can enter the laboratory testing ordered on the log.Review of the facility provided Lab Monitoring Sheet for July 7, 2025, and July 8, 2025, failed to reveal documentation the CMP, CBC and Pro-BNP were obtained for Resident #1 as ordered.When asked about the process to track lab orders, the DON said the Unit Managers were responsible to ensure the labs were done, the results obtained and reported to the physician. She said the Unit Managers were supposed to pull the 24-hour report for their assigned unit, including the lab orders. In clinical morning meeting, they go over the order listing report.The DON verified the process was not followed for Resident #1, #2, and #3.On 8/6/25 at 11:41 p.m., in an interview the Regional Nurse said on 8/4/25 when they became aware of the missed blood work for Resident #1, they audited the clinical records for missed labs from 7/5/25 through 8/5/25. During the audits, they identified 13 other residents with Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105588 If continuation sheet Page 4 of 5 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 08/06/2025 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)

F 0770 missing labs, including Residents #2 and #3. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105588 If continuation sheet Page 5 of 5