Inspection visit
Inspection
11 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 11 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, interviews and record review, the facility failed to provide care in a manner to maintain a
resident's dignity for 47 residents on the South unit, including Resident #18.
The findings included:
The facility's policies and procedures for Dignity did not address dignity during dining.
1). Resident #18 was admitted to the facility on [DATE]. According to the resident's most recent
assessment, a Quarterly Minimum Data Set (MDS), dated [DATE], Resident #18 had a Brief Interview fore
Mental Status score of 02, indicating severe cognitive impairment. The MDS documented that the resident
was dependent upon staff for eating. Resident #18's diagnoses at the time of the assessment included:
Anemia, Diabetes, Cerebrovascular incident, Non-Alzheimer's Dementia, Hemiplegia, Seizure disorder,
Malnutrition, Depression, Epilepsy, contracture of muscle left upper arm. Cognitive communication deficit,
Dysphagia, Muscle weakness, Limitation of activities due to disability.
During an observation of breakfast, on 03/12/24 08:43 AM, it was noted that Resident #18 had not been
served breakfast. During an interview with Staff A, LPN, while standing directly outside of the resident's
room, when asked about Resident #18 not being served breakfast, Staff A replied, She is a feeder, when
the CNA (Certified Nurse's Assistant) is finished with another resident, she will feed her.
2). On 03/13/24 at 8:25 AM, Resident #18 was observed in bed with breakfast on over bed table and being
fed by Staff B, LPN. It was noted that Staff B was standing at the resident's right side of bed to feed her.
When asked about standing next to the resident Staff B acknowledged that she should have been seated to
feed the resident, There wasn't a chair in the room, and I recognized that the food was getting cold.
3). During an observation of lunch being served to the residents in their rooms on the South Unit, on
03/13/24 at 11:58 AM, Staff C, CNA was instructed to go to the dining room by another staff member. Staff
C replied by yelling out, I can't, I have feeders. At the time of the observation, Staff C was at the room at the
end of the unit close to the emergency exit and could be heard by this Surveyor from the nurse's station,
approximately 90 feet from away, according to the Regional Director of Plant Operations.
During an interview with Staff C at the time of the observation, Staff C acknowledged that she had referred
to the residents as feeders and understood the concerns.
(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 14
Event ID:
105611
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0550
Level of Harm - Minimal harm
or potential for actual harm
During an interview, on 03/13/24 at approximately 12:30 PM, the Administrator acknowledged
understanding of the concerns and replied that the staff would be in-serviced.
During an interview, on 03/14/24 at 3:00 PM, the Regional Nurse Consultant stated that the facility did not
have a policy and procedure specific to dignity during dining.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 2 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 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
record review and interview, the facility failed to ensure that a complete and accurate Pre-admission
Screening and Resident Review (PASARR) was completed for 1 of 2 residents reviewed, Resident #60.
Residents Affected - Few
The findings included:
Resident #60 was admitted to the facility on [DATE]. According to the resident's most recent assessment, a
Quarterly Minimum Data Set (MDS), dated [DATE], Resident #10 had a Brief Interview for Mental Status
score of 10, indicating that the resident was moderately cognitively impaired.
In Section IA of the resident's PASARR, completed by the resident's Attending Physician on 05/11/23, the
PASARR documented that Resident #60 had diagnoses that included: Anxiety Disorder, Depressive
Disorder and Agoraphobia. Section 1B of the PASARR documented that Resident #60 had functional
limitations in major life activities that included: Capacity for independent living, Self-care, and Self direction.
Section I documented that the resident previously received services for Mental illness and had been
referred for Mental Illness Services. The findings of the Level I PASARR was based on documented History,
Behavioral Observations and Medications.
Sectio II-2 of the PASARR documented that the resident had the following difficulties with: Interpersonal
functioning, Concentration, persistence and pace, and Adaptation to change.
Section II-3 of the PASARR documented, Due to the mental illness, the individual has experienced an
episode of significant disruption to the normal living situation for which supportive services were required to
maintain functioning at home, or in a residential treatment environment, or which resulted in interventions
by housing or law enforcement.
The PASARR instructs the person that is completing the assessment, A Level II PASARR evaluation must
be completed prior to admission if any box in Section 1.A or 1.B is checked and there is a 'yes' checked in
Section II.1, II.2 or 11.3, unless the individual meets the definition of a provisional admission or a hospital
discharge exemption.
Section IV of the PASARR was not completed to determine if Resident #60, 'may be admitted to an NF.
During an interview, on 03/14/24 at 3:33 PM with the Social Services Director, when asked about Resident
#60's PASARR not being completed, the Social Services Director stated, I submitted for a Level II and it
was declined.
The Social Services Director provided documentation of a response from the request for the Level II
screening, dated 02/27/24, that documented:
We can't complete the screening.
This case is being closed due to an incomplete submission packet.
The Social Services Director stated that she had not followed up on the response to the request being
declined.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 3 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0679
Provide activities to meet all resident's needs.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to provide activities to meet the needs and
interests for 1 of 2 residents reviewed for Activities, Resident #60.
Residents Affected - Few
The findings included:
Resident #60 was admitted to the facility on [DATE]. According to the resident's most recent assessment, a
Quarterly Minimum Data Set (MDS), date 12/27/23, Resident #60 had a Brief Interview for Mental Status
score of 10, indicating that the resident was moderately cognitively impaired. The MDS documented that
Resident #60 required substantial/maximal assistance for activities of daily living, except for eating.
Resident #60's diagnoses at the time of the assessment included: Anxiety disorder, Depression, Psychotic
disorder, Rheumatoid arthritis, Agoraphobia, Chronic pain.
A care plan, dated 12/27/23, with a revision date of 03/11/24, documented, The resident experiences
loneliness and or isolation.
The goal of the care plan was documented as, The resident will express feelings around loneliness and
isolation with a target date of 05/30/24.
Interventions to the care plan included: Encourage resident to express feelings of loneliness and isolation.
Further review of Resident #60's electronic health record revealed that there was no care plan for Activities.
A 'Community Life Progress Review (Activities assessment), dated 01/03/24, documented that the resident
'Prefers to watch TV'.
On 03/12/24 at 9:58 AM, Resident #60 was observed in bed in wearing a hospital gown. The resident's
roommate stated that Resident #60 had not been out of bed during the previous 3 weeks. When Resident
#60 was asked if the statement by her roommate was accurate, Resident #60 nodded agreement with the
statement made by the roommate. The resident was informed by this Surveyor about the activity involving
Baking Cookies that was scheduled for this day in the afternoon and resident was visually excited to attend.
During the interview and observation, it was noted that the television was turned off and the remote control
for the television was on the resident's overbed table that was not in the resident's reach.
On 03/12/24 at 2:29 PM 8 residents were observed in the Activity room while cookies were being baked for
the residents and the residents were being served beverages by the Activities staff. It was noted that
Resident #60 was not among the 8 residents in attendance. Interview with resident - was asked if she
wanted to attend the activity and nodded head up and down in a 'yes' manner.
During an interview, on 03/12/24 at 2:34 PM Staff F CNA, when asked about Resident #60 being out of bed
and participating in activities, Staff F replied, she just moved rooms. It is not normal for her to be in bed.
Sometimes she gets up. I washed and put a clean gown on her. There was no clean clothes in the closet.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 4 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0679
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
On 03/12/24 at 2:40 PM, an observation of Resident #60's closet noted that there were 3 pairs of pants and
several shirts. Resident #60 confirmed that the clothing was hers and was unsure of any missing clothing
since being moved from another unit.
During an interview, on 03/13/24 at 7:14 AM, with Staff G, LPN, when asked about Resident #60's
participation in activities and being out of bed, Staff G replied, She has therapy get her out of bed,
sometimes she wants to stay in bed and you cannot force them to get out of bed. The CNAs get them in the
chair and the Activities come and get them. When asked of the most recent time that Resident #60 had
been out of bed, Staff G replied, a couple of weeks ago before lunch. I think it was for activities.
During an interview, on 03/13/24 at 7:27 AM, with Staff A, LPN, when asked about Resident #60 being out
of bed and participating in activities, Staff A replied, yesterday was the first day that I worked with her for a
while. Her roommate said that she didn't feel like getting up. After PT, she will go to activities. The Activities
will come and ask them if they want to go.
During an interview, on 03/13/24 at 10:15 AM, the Activities Director stated that she tries getting residents
to do exercise, they don't want to, they just want to sit and drink coffee. Every once in a while a couple of
them will, but this is what they want.
On 03/13/24 at 4:55 PM, Resident #60 was observed in her wheelchair in her room, with the television
turned off and the remote control for the television on the overbed table that was out of the resident's reach
and no other source of stimulation noted.
During an interview, on 03/13/24 at 5:39 PM, with The Therapy Director, when asked about Resident #60
participating in therapy, the Therapy Director replied, I just finished with her - 03/11/24 was my last day with
her. Speech Therapy projected discharge is tomorrow (03/14/24). I usually work with her in the room. When
asked about assisting the resident to Activities at the completion of therapy, the Therapy Director replied,
more often than not she would rather sit in her room and watch TV. When asked about the resident's
physical and cognitive ability to operate the television remote control, the Therapy Director replied, her
cognition is not as good. She has her good days and her not so good days. If she had a good night, she is
more engaging and alert. Her cognition varies. She has the physical capacity to use the remote, but not
always the cognitive ability.
On 03/14/24 at 10:15 AM, Resident #60 was observed in bed with television off and remote control on over
bed table that was out of the resident's reach and no other source of stimulation noted.
During an interview, on 03/14/24 at approximately 10:30 AM, with the Activities Director, the Activities
Director stated that she had started a care plan for Activities for the resident this morning. The Activities
Director further stated that the resident also enjoys books and 1:1 visits. During the observation and
interview, Resident #60 was in bed with television off and remote control out of reach and books on her
nightstand to the resident's right side of bed also out of reach.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 5 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interviews, policy and record review; the facility failed to provide care and services to prevent a
potential decline in a resident's physical and/or psychosocial well-being for 1 of 5 sampled residents,
reviewed for unnecessary medications (Resident #62).
Residents Affected - Few
The findings included:
The facility's policy titled, Medical Care/Standard of Practice with an effective date of 11/30/14 and revision
date of 03/03/21, revealed The attending physician will complete a history and physical (H&P) on all
residents as required by the applicable state law. In the event the admitting physician is new to the resident,
the admitting physician shall complete an H&P on the resident within 48 hours of admission.
Resident #62 was admitted to the facility on [DATE] post hospitalization for Personal history of traumatic
brain injury, Pedestrian on foot injured in a motor vehicle accident and Traumatic subarachnoid hemorrhage
with loss of consciousness.
Resident #62 was unable to perform the Brief Interview for Mental Status (BIMS) and was unable to speak.
In an interview with the resident on 03/11/24 at 10:15 AM the resident was able to nod her head to indicate
that she understood the questions asked but could not respond except for nodding her head.
Upon admission to the facility, the resident was on Enoxaparin Sodium (Lovenox) Injection Solution
Prefilled Syringe 30 milligrams (mg) per 0.3 milliliter (ml). Instructions were to inject 30 mg intramuscularly
two times a day for DVT (deep vein thrombosis). Enoxaparin sodium is an anticoagulant that helps to
prevent formation of blood clots.
A review of Enoxaparin sodium was done on the Food and Drug Administration (FDA) site. Lovenox
(Enoxaparin sodium) must not be administered by intramuscular injection. Lovenox (enoxaparin sodium
injection), is for subcutaneous and intravenous use. Thrombocytopenia can occur with the administration of
Lovenox. Periodic complete blood counts, including platelet count, and stool occult blood tests are
recommended during the course of treatment with Lovenox.
A review of the medical chart revealed the H&P was done on 01/08/24.
A review of the nursing progress notes and Medication Administration notes revealed on 03/08/24 at 9:35
AM the resident refused Enoxaparin Sodium. The note read she was crying MD (Medical Doctor) notified.
On 03/08/24 a nursing progress note read Patient refused am Lovenox injection, crying saying No, no it
hurts too much Dr notified, who said, noted.
On 03/09/24 a medication administration note stated refused, MD notified.
On 03/10/24 a medication administration note read I don't want it, it hurts. Dr . made aware. Attempted to
call the nurse who wrote these notes on 03/13/24 at 3:53 PM but she did not answer the phone. An
interview was conducted with Staff D, Regional Director of Clinical Services, on 03/14/24 at 4:45 PM who
stated that the nurse had to be referring to the Enoxaparin since it was not given those
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 6 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 - Few
three days and all other medications were given. Staff D also stated at this time that she had been trying to
reach the Physician to have the Enoxaparin Sodium discontinued and after 4 attempts to reach him, he still
did not answer her.
An interview was conducted with Staff E, the Consultant Pharmacist, on 03/13/24 at 09:42 AM. She
produced a pharmacy review dated 01/31/24 for a recommendation for a stop date for Enoxaparin. The
recommendation for a person with an acute illness with decreased mobility was a FDA approved duration of
up to 14 days 30 mg twice a day and up to 3 months with 40 mg daily. Resident #62 had been taking 30 mg
twice a day since 12/28/23. The resident's last Complete Blood Count (CBC) was done 01/03/24 with an
order for it to be repeated in 90 days.
An interview was done with Resident #62's Physician on 03/14/24 at 12:06 PM. The Physician was asked
why the H&P was late on Resident #62 and he had no response as to why. The Physician was asked how
long should Resident #62 have been on Enoxaparin Sodium and he replied she should have been taking it
for 2 weeks. When asked why he did not respond to the recommendation of the consultant pharmacist to
provide a stop date on 01/31/24 he replied that he did not see the recommendation. He stated that he
wanted Resident #62 to see a trauma doctor to regulate the Enoxaparin Sodium for which he told the
Director of Nurses. When asked where the referral was for her to see a trauma doctor he stated he probably
did not write one and he will do better next time. When asked where the progress notes were from his visits
to Resident #62 in January 2024 and February 2024 he stated they were in his office and he will email
them.
On 03/14/24 at 4:00 PM the progress notes arrived to the facility. Reviewed the notes for January and
February 2024. On 02/24/24 the Physician wrote under medications that the resident was receiving
Lovenox indicating he was aware that she was still taking this medication.
The Lovenox was discontinued on 03/13/24.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 7 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0688
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM
and/or mobility, unless a decline is for a medical reason.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, interviews and record reviews, the facility failed to provide services to prevent further
decrease in range of motion for 1 of 1 resident reviewed for range of motion, Resident #18.
The findings included:
Resident #18 was admitted to the facility on [DATE]. According the resident's most recent assessment, a
Quarterly Minimum Data Set (MDS), dated [DATE], Resident #18 had a Brief Interview for Mental Status
score of 02, indicating the resident was severely cognitively impaired. The MDS documented that Resident
#18 was dependent upon staff for all Activities of Daily Living. Resident #18's diagnoses at the time of the
assessment included: Diabetes, Cerebrovascular Accident, Non-Alzheimer's Dementia, Hemiplegia,
Seizure disorder, Malnutrition, Depression, Epilepsy, contracture of muscle left upper arm. Cognitive
communication deficit, Dysphagia, Muscle weakness.
Resident #18's orders included:
Splint. Resting hand splint left hand for up to 8 hours as tolerated, on in the AM/PM off. Monitor skin
integrity before application and removal of device - 02/26/24.
Resident #18's care plan for Activities of Daily Living (ADLs), initiated on 11/21/18 with a revision date of
10/17/22, documented, Resident has an ADL self-care performance deficit related to a history of
cerebrovascular accident, hemiplegia, impaired mobility, arthritis to bilateral knees Non-compliant with left
hand splint.
The goal of the care plan was documented as, The resident will maintain current level of function in ADLs
and mobility thru next review date with at target date of 05/05/24.
Interventions to the care plan included:
*Encourage and assist with turning and repositioning every shift and PRN.
*Left resting hand splint to be worn 8 hours or as tolerated daytime wear, maintain clean dry hand with nails
cut to prevent skin breakdown.
On 03/12/24 at 9:06 AM, Resident #18 was observed in bed with the head of bed elevated. It was noted
that Resident #18 was not wearing a splint device on either hand.
On 03/12/24 at 11:49 AM Resident #18 was observed in her wheelchair at the nurse's station and did not
have a splint or device on her hand.
On 03/12/24 at 1:48 PM, Resident #18 was observed in in her wheelchair at the nurse's station and did not
have a splint or device on her hand.
On 03/13/24 10:18 AM, Resident #18 was observed up in high backed wheelchair in her room and did not
have a splint device on her hand.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 8 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0688
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
On 03/13/24 at 11:25 AM, Resident observed in high back wheelchair in Activities room and did not have a
splint device on her hand.
A review of Resident #18's electronic health record revealed no documentation of the resident refusing or
not tolerating the use of the splint device. On an ADL task worksheet, CNA (Certified Nursing Assistants)
staff documented that the resident wore the splint device daily for the previous 2 week period, including
during the observations made and documented by this Surveyor. On another worksheet, CNA staff
documented that the device was put on daily and that the device was only documented to be removed
once.
During an interview, on 03/13/24 at 11:56 AM, with Staff F, CNA, when asked about applying the splint
device to Resident #18's left wrist and hand, Staff F replied, I put it on when I got her up in the morning at
around 10:00 when they put her to bed, they take it off. I leave at 3:30 she had the brace on when I left.
Sometimes it hurts and she doesn't have it on for very long. At the conclusion of the interview, Staff F was
asked to show this Surveyor the device. Saff F led this Surveyor to the resident's room. Upon arriving to the
resident's room, Staff F was unable to locate the device immediately. After a few minutes, the splint device
was found in the top drawer of the night stand to the resident's right side of bed. Staff F confirmed that she
was the staff member that documented putting the splint device on the resident on the task worksheet.
During an interview, on 03/13/24 at 4:38 PM with Staff H, CNA for 8 months, when asked about the use of a
splint device for Resident #18, Staff H replied, When I came in, she had the brace and I put her back to
bed, when I put her back to bed, I took it off because she can't be in the bed with the brace. Staff further
stated that the resident had no problems or pain with the splint device, When I am here, I work 2 days with
her and Staff F puts it on and I take it off. Staff confirmed that she was the staff member that documented
taking the splint device off of the resident on the ADL worksheet.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 9 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0699
Provide care or services that was trauma informed and/or culturally competent.
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 record reviews, the facility failed to provide services to a resident with
Post-Traumatic Stress Disorder (PTSD) in a manner to prevent being further traumatized for 1 of 1 resident
reviewed for behavioral health, Resident #51.
Residents Affected - Few
The findings included:
The facility's policy for 'Trauma Informed Care' dated 10/24/22, documented:
Residents will be evaluated to identify a history of trauma, triggers and cultural preferences.
Resident-centered interventions are initiated based on the resident triggers and preferences to decrease
the risk of re-traumatization.
Procedure:
1. Residents are evaluated for trauma, triggers, and cultural preferences on admission/readmission,
quarterly and annually.
2. Develop resident-centered interventions based on trauma triggers and resident cultural preferences.
3. Develop a care plan and add interventions to the nurse aide [NAME].
4. Review and update care plan and intervention quarterly and as needed.
Resident #51 was admitted to the facility on [DATE]. According to the resident's most recent assessment, a
Quarterly Minimum Data Set (MDS), dated [DATE], Resident #51 had a Brief Interview for Mental Status
score of 15, indicating that the resident was cognitively intact. Resident #51's diagnoses upon admission
included: Major depressive disorder, Anxiety disorder, Post-Traumatic Stress Disorder, Bipolar disorder,
Personal history of suicidal behavior, Nicotine dependence and Tachycardia.
Resident #51's care plan for Activities of Daily Living (ADLs), initiated on 03/16/23 with a revision date of
03/25/23, documented, The resident has an ADL self-care deficit related to Rheumatoid Arthritis, Obesity,
PTSD, Depression, Anxiety, and Neuropathy.
Further review of Resident #51's records revealed no care plan related to the resident's diagnosis of PTSD.
During an interview with Resident #51, on 03/11/24 at 2:56 PM, when asked about the diagnosis of PTSD,
Resident #51 stated, I have PTSD from being raped when I was 8 years old until I was 12. When asked
about the triggers associated with the diagnosis of PTSD, Resident #51 replied, Yelling and loud screaming
and I can't look at knives. My daughter was murdered in front of me. They have me on Prezacin for night
terrors and I think that it needs to be changed - over the past couple of nights, I have been having very vivid
dreams about my brother and my daughter. I guess we are waiting on the psychiatrist - she wasn't here
yesterday. I don't get angry at other people. I was told that I have survivor's guilt.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 10 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0699
Level of Harm - Minimal harm
or potential for actual harm
During an interview, on 03/13/24 at 7:09 AM, with Staff G, LPN, when asked about Resident #51's PTSD
and behaviors, Staff G replied, sometimes when she speaks with other residents, she gets agitated and
sometimes she is crying because of her children. She tells a story that she was raped. I don't really know
what happens that she gets agitated when talking to the other residents. When asked about the triggers
and behaviors associated with them, Staff G replied that she was not aware of triggers.
Residents Affected - Few
During an interview, on 03/13/24 at 7:24 AM, with Staff A, LPN, when asked about Resident #51's behavior,
Staff A replied, She is like sometimes confused, she can tell you something and then she will forget. She
has a mood where sometimes she talks a lot, and she cries. For me she always laughs, I talk with her, and
she likes that. When asked about Resident #51's PTSD and the triggers and behaviors associated with the
PTSD, Staff A replied, I'm not really sure. For me she is always good and happy, she never gets angry and
mad with me. She likes when I am working with her. She gets ibuprofen and she gets anxiety medications. I
can see her mood change after she gets her medications, and she is more relaxed and talking.
During an interview, on 03/13/24 at 11:56 AM, with Staff F, CNA, when asked about Resident #51's PTSD
and the triggers and behaviors associated the PTSF, Staff F was not able to demonstrate awareness or
knowledge of PTSD.
During an interview, on 3/13/24 at 4:44 PM, with Staff H, CNA, when asked about Resident #51 having
PTSD and the triggers and behaviors associated with the resident's PTSD, Staff H stated that she was not
familiar with resident's diagnosis of PTSD or triggers and behaviors.
During a follow up interview with Resident #51, on 03/13/24 at 4:52 PM when asked about how she reacts
to the triggers to the PTSD, Resident #51 replied, loud noises like yelling and arguing, I will revert back to
being like a little girl and pulling my covers up over my head and I become very disconnected. I won't get
out of bed and I won't let them provide care. Resident #51 stated that it had most recently happened 'a
couple of weeks ago'.
During an interview, on 03/14/24 at 3:33 PM, with the Director of Social Services, when asked about there
not being a care plan for Resident #51's PTSD and associated triggers and behaviors, and the lack of
knowledge of the diagnosis demonstrated by facility staff, the Director of Social Services acknowledged that
there was not a care plan. The Social Services Director stated that she would implement a care plan and
provide in-service training to the staff.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 11 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0756
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart,
following irregularity reporting guidelines in developed policies and procedures.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review and interview, the facility failed to respond to pharmacy recommendations for 2 of 5 residents
reviewed for unnecessary medications (Residents #28 and #62).
The findings included:
1. Resident #28 was admitted to the facility on [DATE] with diagnoses included Diabetes. A comprehensive
assessment dated [DATE] documented the resident had mild cognitive impairment, required
substantial/maximal assistance with activities of daily living. The assessment further documented the
resident was receiving insulin injections, antidepressants, anticoagulants (blood thinners), and diuretics.
A 6 month review of Consultant Pharmacist Medication Regimen Review was conducted. The review
revealed no physician's response to pharmacy recommendations on 11/30/23, 01/31/24, and 02/19/24.
Pharmacy recommendation 02/19/24 : Allegra 180 milligrams at night which was started on 06/18/23.
Please consider discontinuing to reduce polypharmacy.
Pharmacy recommendation 01/31/24: The resident is taking Montelukast. Montelukast side effects include
the following neural psychiatric symptoms and roughly 14% of patients which include agitation, aggression,
anger, anxiety, depression, hallucinations, hostility, irritability, nervousness, sleep disorders, and
restlessness. May want to consider other drug therapy as Montelukast may be result in the need for anti
psychotic drug therapy.
Pharmacy recommendation 11/30/23: Insulin solution sliding scale. In an effort to keep this facility
compliant to CMS regulations for long term care facilities please evaluate risk for versus benefit of
continued use of sliding scale insulin. It is listed on the Beer list of potentially inappropriate drugs in the
elderly due to poor efficacy and potential for hypoglycemia. American Diabetes Association advises against
utilizing sliding scale as insulin monotherapy in elderly populations. Long term use is generally not
recommended. For continued use, rationale and risk versus benefit should be documented in the residents
medical record. Recommendation: Please evaluate continued use of sliding scale in light of the above. If
blood sugar remains uncontrolled, suggest adjusting routine therapy, if clinically appropriate. If benefits of
sliding scale outweigh risk, please document clinical rationale below or in your progress note.
Further review of the pharmacy recommendations revealed there is no evidence of any pharmacy review
for the months of October 2023 or August 2023.
A review of resident #28's current physician orders on 03/14/24 revealed the resident was receiving Allegra,
Montelukast, and sliding scale insulin. A review of the resident's physician progress notes did not address
the pharmacist recommendations.
An interview was conducted with the Consultant Pharmacist on 03/14/24 at 10:00 AM, who acknowledged
the above.
2) Resident #62 was admitted to the facility on [DATE] post hospitalization for Personal history of
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 12 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0756
traumatic brain injury, Pedestrian on foot injured in a motor vehicle accident and Traumatic subarachnoid
hemorrhage with loss of consciousness.
Level of Harm - Minimal harm
or potential for actual harm
A review of the Consultant pharmacist recommendations revealed:
Residents Affected - Few
12/30/23 no recommendation.
1/31/24 recommendation for stop date for Enoxaparin.
2/19/24 no irregularities.
An interview was conducted on 03/13/24 at 9:42 AM with Staff E , the consultant pharmacist, regarding the
recommendation to stop Enoxaparin on 01/31/24. She stated she was planning on making another
recommendation to discontinue Enoxaparin in March since the recommendation done in January was not
acted on. She stated she usually waits a month before repeating a recommendation. Staff E was asked
what type of monitoring would be done for a resident on Enoxaparin and she replied that likely a Complete
Blood Count (CBC) would be done.
An interview was conducted on 03/13/24 at 3:00 PM with Staff D, Regional Director of Clinical Services,
who stated there has been no response to the consultant pharmacist's recommendations for Resident #62.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 13 of 14
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
105611
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Greenacres
6414 13th Rd S
Green Acres, FL 33415
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 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
Based on record review and interview, the facility failed to keep complete and accurate records for 19 of 19
records reviewed (Residents #5, #13, #17, #18, #24, #27, #28, #32, #34, #40, #41, #50, #51, #60, #61,
#62, #64, #68, and #222).
The findings included:
A review of #28's records revealed no physician notes since May 2023. An interview was conducted with
the Nursing Home Administrator (NHA) on 03/13/24 at 10:00 AM. The NHA stated the physician progress
notes should be in the resident's electronic records and done monthly. Surveyor requested the last 3
months of physician progress notes. The NHA stated she would get in touch with the physician to inquire
about the physician notes.
An interview was conducted with the NHA on 03/13/24 at 3:00 PM. The NHA produced 3 months of
physician notes for 12/24, 01/24, and 02/24. The NHA could not answer why the physician notes were not
part of the resident's records. The physician notes were handwritten and illegible. Surveyor requested the
last 3 months of physician progress notes for the rest of the sampled residents (Residents #5, #13, #17,
#18, #24, #27, #32, #34, #40, #41, #50, #51, #60, #61, #62, #64, #68, and #222).
On 03/14/24, the NHA provided written physician progress notes for Residents #5, #13, #17, #18, #24, #27,
#32, #34, #40, #41, #50, #51, #60, #61, #62, #64, #68, and #222. The written physician progress notes
were illegible.
An interview was conducted with the Medical Director/attending physician for the facility's residents on
03/14/24 at 10:00 AM. The Medical Director stated resident's physician progress notes were kept in his
office. The Medical Director acknowledged the progress notes should be in the resident's records. The
Medical Director stated, I'll do better. When questioned on the illegible written progress notes, the Medical
Director stated he did not have access to the electronic medical records for documentation.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105611
If continuation sheet
Page 14 of 14
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Back to topCitations
11 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.
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F645 - Preadmission Screening for individuals with a mental disorder and individuals
PASARR screening for Mental disorders or Intellectual Disabilities
F679 - Activities
Provide activities to meet all resident's needs.
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F688 - Mobility
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
F699 - Trauma-informed care
Provide care or services that was trauma informed and/or culturally competent.
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
- 0351GeneralS&S Dpotential for harm
Install an approved automatic sprinkler system.
F712 - Frequency of physician visits
Have simulated fire drills held at unexpected times.
- 0355GeneralS&S Dpotential for harm
Properly select, install, inspect, or maintain portable fire extinguishes.
FAQ · About this visit
Common questions about this visit
What happened during the March 14, 2024 survey of AVIATA AT GREENACRES?
This was a inspection survey of AVIATA AT GREENACRES on March 14, 2024. The surveyor cited 11 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at AVIATA AT GREENACRES on March 14, 2024?
Yes, 11 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."
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
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.