Health inspection·January 22, 2025

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to provide necessary treatment to promote healing and prevent infection for an identified pressure ulcer for one (#5) of three residents reviewed. Residents Affected - Few Findings included: Review of Resident # 5's Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form (3008), dated 10/21/24, showed on 10/6/24, a surgical procedure was performed on the left hip. Review of Resident #5's admission record showed admission to the facility on [DATE] and transferred to the hospital on [DATE], with diagnoses to include left femur fracture, muscle weakness, muscle wasting, dementia and on 11/19/24 the onset of stage 3 pressure ulcer of the sacrum on 11/19/24. Review of Resident #5's Order Summary Report showed orders to include consult wound care as needed (PRN), order dated 11/19/24 low air loss mattress for Stage 3 pressure area to coccyx. An order date 11/19/24, start date, 11/20/24 to cleanse sacrum area with wound cleanser and pat dry, apply nickel thick layer of Santyl to wound bed, cover with calcium (CA) alginate and secure with bordered gauze change daily and as needed (PRN) for soiling and dislodgement every day shift for wound care. Review of Resident #5's Admission/ readmission Data Collection record, dated 10/22/24, Section M: Skin showed right hip surgical incision. Review of Resident #5's admission Minimum Data Set (MDS), dated [DATE], revealed in Section C: Cognitive Patterns, a Brief Interview for Mental Status (BIMS) score of 7, which indicated severe cognitive impairment. In Section GG: Functional Abilities revealed Resident #5 required substantial/maximal assistance to roll from lying on back to the left and right sides. In Section M: Skin Conditions revealed Resident #5 is at risk for developing pressures ulcers and does not have one or more unhealed pressure ulcers. Review of Resident #5's Treatment Administration Record, dated November 2024 showed an order to cleanse sacrum area with wound cleanser and pat dry, apply nickel thick layer of Santyl to wound bed, cover with calcium (CA) alginate and secure with bordered gauze change daily and as needed (PRN) for soiling and dislodgement every day shift for wound care, start date 11/22/24. Treatment was documented as completed on 11/23/24 only. An order for weekly skin sweeps every night shift every Tuesday for Resident #5 showed skin was checked on 11/5, 11/12 and 11/19. The checks did not reveal concerns with new or worsening of skin conditions. (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: 105951 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 105951 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Oakfield 1465 Oakfield Dr Brandon, FL 33511 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)