Health inspection·May 8, 2025

F 0641 Ensure each resident receives an accurate assessment. 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 ensure Minimum Data Set (MDS) assessments were accurate related to special treatments, procedures and programs for 3 of 3 residents reviewed for accuracy of assessments, of a total sample of 40 residents, (#4, #8 and #46). Residents Affected - Few Findings: 1. Resident #4 was admitted to the facility on [DATE] with diagnoses including epilepsy, chronic respiratory failure with hypoxia, and tracheostomy status. Review of the MDS quarterly assessment with assessment reference date (ARD) 2/21/25 revealed resident #4 had a Brief Interview for Mental Status (BIMS) score of 15/15 which indicated she was cognitively intact. The assessment indicated resident #4 received tracheostomy (a hole in the throat for breathing) care and dialysis. On 5/06/25 at 11:53 AM, resident #4 was reclined in bed with the head of the bed elevated. Resident #4 stated she did not go to dialysis. Resident #4 clarified she did not receive dialysis and had never received dialysis. 2. Resident #8 was admitted to the facility on [DATE] with diagnoses including nontraumatic brain bleed, acute respiratory failure with low oxygen and encounter for attention to tracheostomy. Review of the MDS quarterly assessment with ARD 1/25/25 revealed resident #8 had long-term and short-term memory problems and severely impaired cognitive skills for daily decision making. The assessment indicated resident #8 received tracheostomy care and had an invasive mechanical ventilator for breathing. On 5/06/25 at 10:25 AM, resident #8 was reclined in bed with the head of the bed slightly elevated. Tracheostomy tubing was in place. No ventilator tubing or equipment for a mechanical ventilator was seen in the room. On 5/07/25 at 10:28 AM, in resident #8's room, the MDS Coordinator and the A Wing Unit Manager verified resident #8 had a tracheostomy but did not use a ventilator for breathing. 3. Resident #46 was admitted to the facility on [DATE] with diagnoses that included bladder inflammation with blood in the urine. Review of the MDS admission assessment with ARD 3/28/25 revealed resident #46 had a BIMS score of (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: 105706 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 105706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vivo Healthcare West Orange 1556 Maguire Rd Ocoee, FL 34761 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)