Health inspection·June 7, 2023

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interview, the facility failed to notify the Office of the State Long Term Care (LTC) Ombudsman of residents' transfers and discharges from 4/14/23 through 06/6/23 including 1 of 5 sampled residents, (#2). Findings: Resident #2 was admitted to the facility on [DATE] and discharged home on 5/25/23. Review of resident #2's medical record revealed no documentation of notification to the Long-Term Care (LTC) Ombudsman's office. On 6/07/23 at 11:48 AM, the Director of Nursing (DON) stated he was not sure of the timeframe for notification to the Ombudsman for resident transfers and discharges. He noted that was handled by the Social Services Director. On 06/7/23 at 2:53 PM, the Social Services Director stated notification to the Ombudsman had not been done since December 2022. She stated the previous social worker left in March 2023 and she took over at that time. I didn't know anything about it. She stated she had not received any training in her orientation for notifying the Ombudsman of resident transfers and discharges. She noted, I just found out today that the Ombudsman notification is the responsibility of Social Services. On 6/07/23 at 3:50 PM, an email reply from the Ombudsman's office revealed the last discharge they received was a 30-day notice dated 4/13/23. The email noted the facility faxed the transfers and discharges to the office, and they had not received any other notices from the facility since 4/13/23. On 6/07/23 at 4:04 PM, the Administrator stated the facility ensured the Ombudsman's office was aware of all residents discharged and transferred from the facility. She explained the transfer or discharge form was completed and presented to the Ombudsman when they visited the facility. She stated she did not know the Social Services Director was not aware to send notifications to the Ombudsmen. She stated notification to the Ombudsman was the responsibility of the Social Services Director. She confirmed there were no specific times for sending notifications to the Ombudsman's office. She stated the last time the Ombudsman was notified of resident's transfers and discharges was April of this year (2023). She said, I do not have any documentation of the Ombudsman reviewing the notifications while visiting the facility. She stated the facility had a binder for the Ombudsman to review the notifications but unable to locate it at this time. On 06/7/23 at 6:03 PM, the Administrator and Social Services Director both confirmed they had not Page 1 of 5 105985 105985 06/07/2023 Aviata at Palm Bay 5405 Babcock St NE Palm Bay, FL 32905

F 0623 located the notification binder for residents discharged and transferred. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy and procedure for Transfer/Discharge Notification and Right to Appeal with a revision date of 10/24/22, revealed before a center transfers or discharges a resident, the center must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman. Residents Affected - Some 105985 Page 2 of 5 105985 06/07/2023 Aviata at Palm Bay 5405 Babcock St NE Palm Bay, FL 32905

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to implement the plan of care and obtain a physician order for discharge for 1 of 1 resident out of a total sample of 5 residents reviewed for Admission, Transfer and Discharge Rights, (#1). Findings: Resident #1 was initially admitted to the facility on [DATE] then readmitted on [DATE] from the hospital with diagnoses of pressure ulcer left buttock, type 2 diabetes, and urinary retention. He was discharged on 5/27/23 to another facility out of state. Review of the Minimum Data Set (MDS) significant change assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15 out of 15 which indicated the resident was cognitively intact. The assessment noted the resident required extensive assistance from staff for transfers, toileting, and personal hygiene. Review of a Care Plan initiated 9/3/21 and revised on 11/24/21 noted the resident wished to return to home with family with interventions to establish a pre-discharge plan with resident/representative, evaluate progress and revise plan as needed. Review of nurses progress note dated 5/27/23 at 2:11 PM, read, resident discharged . A Social Services note dated 5/29/23 at 11:12 AM, revealed resident #1 was discharged out of state to Virginia. Review of physician orders 5/1/23 through 5/27/23 revealed no order for the resident to be discharged . On 6/7/23 at 7:40 PM, the Administrator and the Director of Nursing (DON) confirmed there was no physician discharge order for resident #1. The DON stated a discharge order was to be obtained from the doctor, entered into the electronic system, and medications sent to the pharmacy. He stated residents discharged from the facility should have a physician order for discharge. Review of the facility policy and procedure for Physician Orders with a revision date of 3/3/21 revealed the center will ensure that Physician orders are appropriately and timely documented in the medical record. 105985 Page 3 of 5 105985 06/07/2023 Aviata at Palm Bay 5405 Babcock St NE Palm Bay, FL 32905

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to complete a discharge summary that included a final summary of the resident's stay in the facility, reconciliation of discharge medications, and a post discharge plan of care for 2 of 2 residents out of a sample of 5 residents reviewed for Admission, Transfer and Discharge Rights (#1, #2). Findings: 1. Resident #1 was readmitted to the facility on [DATE] with an original admission date of 7/26/21. His diagnoses included paraplegia, chronic bladder-neck obstruction, type 2 diabetes, atrial fibrillation, depressive disorder, and chronic pressure ulcer. Review of the medical record revealed the resident was discharged on 5/27/23 to a facility out of state. A care plan initiated 9/3/21 and revised on 11/24/21 noted the resident wished to return to home with family with interventions to establish a pre-discharge plan with resident/representative, evaluate progress and revise plan as needed. A Discharge Plan and Instructions form dated 5/26/23 at 9:11 AM, noted the form was blank including advance directive, physician information, pharmacy, office visits, home health services, medical equipment, summary of stay, reason for discharge, services provided, care plan goals, labs, diagnostics, skin, pain evaluations, discharge summaries for activity, social services, nursing, nutrition, therapy, and treatment summary. There was no discharge summary in the medical record. 2. Resident #2 was admitted to the facility on [DATE] with previous admission on [DATE] with diagnoses of chronic respiratory failure with hypoxia, hypertension, dependence on oxygen, cardiopulmonary disease, anxiety disorder, and unsteadiness on feet. Resident #2 was discharged home on 5/25/23. Review of the Minimum Data Set (MDS) discharge assessment with assessment reference date (ARD) 5/25/23 showed Brief Interview Mental Status (BIMS) score of 14 out of 15 which indicated the resident was cognitively intact. A Social Services progress note dated 5/25/23 at 11:55 AM, noted the resident was discharged home today per son. A Discharge Plan and Instructions form dated 5/25/23 at 11:28 AM, showed no documentation for receiving medical equipment, the functional Mobility/Self Care Skills section was blank, along with the nutrition section. The discharge summaries section for activity, nursing, and therapy were blank. The section for discharge body audit of skin was blank and there was no discharge summary located in the medical record for resident #2. On 6/7/23 at 6:56 PM, the Director of Nursing (DON) stated the residents were supposed to have discharge summaries. He confirmed resident #1 and resident #2 did not have discharge summaries in their medical records. He stated all departments were to complete the discharge summaries for their sections and sign the form. He stated it should have been checked by Social Services to ensure all sections were completed when the resident was discharged . 105985 Page 4 of 5 105985 06/07/2023 Aviata at Palm Bay 5405 Babcock St NE Palm Bay, FL 32905

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 6/7/23 at 7:07 PM, the Social Services Director stated it was the nursing department's responsibility for making sure the discharge summaries were completed. She explained she did not receive any orientation regarding discharge summaries, it was not mentioned. Review of the facility's Policies and Procedures Interdisciplinary Discharge Summary with effective date 11/30/14 showed when the facility anticipates discharge, a resident must have a discharge summary completed that includes a recapitulation of the residents stay. Social service personnel or designee will initiate the interdisciplinary Discharge Summary and the following departments from Social services, Nursing Services, Dietary Services, Community Life, Rehab Services will give a final summary regarding the resident's stay in the facility on the Interdisciplinary Discharge Summary. The medical records personnel or designee will ensure the completed Discharge Summary is placed in the resident's medical record. 105985 Page 5 of 5