Inspection·June 30, 2022

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** 2. Clinical record review revealed resident #51 was admitted to the facility on [DATE], with diagnoses which included Chronic Obstructive Pulmonary Disease (COPD), atrial fibrillation, and systolic (congestive) heart failure. Residents Affected - Few Review of the resident's clinical record revealed a physician order dated 2/28/22 for Oxygen at 2 liters per minute via nasal cannula every shift related to COPD. Review of the resident's MDS Quarterly assessment with ARD of 5/18/22 revealed Section O required documentation of Special Treatments, Procedures, and Programs performed during the last 14 days. However, resident #51's oxygen therapy was not checked. Review of the resident's Treatment Administration Record (TAR) for the period reviewed for the assessment revealed the resident received oxygen during the 7 days look back period. On 6/30/22 at 12:58 PM, the RN MDS Coordinator stated the MDS assessment was completed by doing a 7-day look back, and included observations, interviews with the resident and staff, and review of the resident's clinical records. During review of resident #51's MDS Quarterly assessment with the RN MDS Coordinator, she validated the assessment was not coded to indicate the use of oxygen. The RN MDS Coordinator reviewed the resident's physician orders and TAR and verbalized the resident received oxygen therapy during the assessment period, therefore the MDS assessment was incorrect. Based on observation, interview, and record review, the facility failed to ensure Minimum Data Set (MDS) assessments accurately reflected health conditions related to falls for 1 of 5 residents reviewed for accidents (#608), and respiratory status for 1 of 3 residents reviewed for respiratory care (#51), out of a total sample of 44 residents. Findings: 1. Review of the medical record revealed resident #608 was admitted to the facility on [DATE] from an acute care hospital with diagnoses including epilepsy, hemiplegia, difficulty walking, muscle weakness, lack of coordination, and cerebral infarction (stroke). On 6/27/22 at 4:20 PM, the resident was seated in a wheelchair across from the nurses' station with obvious bruising noted left side of her face. Personal Care Attendant D stated the resident's bruising resulted from a fall 3 to 4 days ago. Initial review of the incident log showed since her admission, the resident had falls on 6/19/22, 6/23/22 and 6/25/22. (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 5 Event ID: 105885 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 105885 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Healthcare and Rehabilitation Center 8050 Spyglass Hill Rd Viera, FL 32940 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)