Health inspection·February 8, 2024

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 record review and interview, the facility failed to ensure resident assessment was accurate for 1 of 3 residents reviewed for discharge, Resident #114. Residents Affected - Some Finding include: Review of Resident #114's summary of discharge date d 12/4/2023 at 6:00 PM showed the resident was discharged to home with spouse/family. Review of Resident #114's Minimum Data Set (MDS) Discharge Return Not Anticipated Assessment, dated 1/4/2024, showed the resident was discharged to an acute hospital on [DATE]. During an interview on 2/7/2024 at 12:37 PM, the Minimum Data Set Coordinator confirmed Resident #114 discharged home and the MDS dated [DATE] was inaccurate. Review of the facility policy and procedures titled MDS last reviewed on 1/24/2024 showed the policy read, Policy: The center conducts initial and periodical standardized, comprehensive and reproducible assessments no less than every three months for each resident including, but not limited to, the collection of data regarding functional status, strengths, weaknesses and preferences using the federal and/or state required RAI. Procedure . Each person completing a section or portion of a section of the MDS signs the Attestation Statement indicating its accuracy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 2 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 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 record review and interview, the facility failed to develop a comprehensive care plan for 1 of 6 residents reviewed, Resident #74. Findings include: 1. Review of Resident #74's admission record revealed the resident was admitted on [DATE] with a diagnosis of malignant neoplasm of brain. Review of Resident #74's palliative medicine consult note dated 6/29/2022 revealed the resident was referred for palliative care services related to diagnoses that included malignant neoplasm of brain, dysphagia, aphasia, and physical deconditioning. Review of Resident #74's palliative care note dated 1/24/2024 revealed the resident continued in receiving palliative care services for the active diagnoses that included adult failure to thrive syndrome, with the medical interventions that included comfort interventions only. Review of Resident #74's care plan with the start date of 12/21/2023 revealed no focus area with goals and interventions related to palliative care. During an interview on 2/7/2024 at 10:28 AM, the Minimum Data Set Coordinator confirmed that palliative care services had not been included in Resident #74's care plan. She confirmed palliative care services should have been included in Resident #74's comprehensive care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 3 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 Based on observation, record review, and interview, the facility failed to ensure that residents received care and services consistent with professional standards of practice for 1 of 5 residents receiving intravenous medication, Resident #216. Residents Affected - Few Findings include: During an observation on 2/7/2024 at 8:11 AM, Staff B, License Practical Nurse (LPN), entered Resident #216's room and performed hand hygiene. Staff B primed Resident #216's intravenous (IV) tubing and sanitized the needleless connector. Staff B did not prime the normal saline flush syringe or check blood return before flushing the peripherally inserted central catheter (PICC) line. During an interview on 2/7/2024 at 8:27 AM, Staff A, LPN, Unit Manager, stated, The nurse should have primed the normal saline syringe before administering it. During an interview on 2/7/2024 at 8:35 AM, Staff B, LPN, stated, I just took the IV refresher course and I don't remember them saying we needed to do that. I always stop short of administering the whole syringe definitely. The class was very detailed but don't remember them mentioning that. Review of Resident #216's physician order dated 2/6/2024 showed the order read, Cefepime HCl [Hydrochloride] Intravenous Solution 2 GM [gram]/100 ML [milliliter]. Use 2 grams intravenously every 12 hours for wound infection until 2/11/2024. Review of Resident #216's physician order dated 2/2/2024 showed the order read, IVs: Flush PICC Line with10 ml of normal saline every shift and as needed. Review of the facility policy and procedures titled Medication Administration with the last review date of 1/24/2024 showed the policy read, Procedure . 8. Prime administration set, if not pre-primed by pharmacy . 10. Maintaining asepsis, attach flush syringe to needleless connector. Aspirate the catheter to obtain positive blood return to verify vascular access patency. Flush with prescribed flushing agent. Remove syringe. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 4 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure residents received respiratory care consistent with professional standards of practice for 1 of 3 residents reviewed for oxygen therapy, Resident #319. Residents Affected - Few Findings include: During an observation on 2/5/2024 at 12:50 PM, Resident #319 was lying in bed with oxygen running at 4 liters per minute via nasal cannula. During an observation on 2/6/2024 at 8:15 AM, Resident #319 was lying in bed with oxygen running at 4 liters per minute via nasal cannula. Review of Resident #319's physician order dated 2/4/2024 showed the order read, Oxygen As Needed PRN 3l [as needed 3 liters] via nasal cannula for shortness of breath as needed. Review of Resident #319's care plan initiated on 1/24/2024 showed the care plan read, Focus: The resident has oxygen therapy r/t [related to] COPD [Chronic Obstructive Pulmonary Disease] . Interventions . Oxygen Setting: O2 [Oxygen] via nasal prongs @ 3L [at 3 liters] as ordered. Humidified (as ordered). During an observation on 2/7/2024 at 8:35 AM with Staff A, Unit Manager, Resident #319 was lying in bed with oxygen running at 4 liters per minute via nasal cannula. During an interview on 2/7/2024 at 8:35 AM, Staff A, Unit Manager, stated, [Resident #319's name] oxygen orders are for 3 liters per minute. I will go back in and correct the flow rate. Review of the facility policy and procedures titled Oxygen Therapy with the last review date of 1/24/2024 showed the policy read, Policy: In the event that a resident requires the use of oxygen to manage a medical condition, The Company will offer assistance as ordered by the resident's physician. Only enrichers, concentrators, and liquid oxygen will be used. Oxygen therapy must be reviewed by the nurse on a regular basis and all staff members offering assistance with oxygen must be properly trained. Procedure: 1. The nurse will organize the oxygen therapy as ordered by the resident's physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 5 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on record review and interview, the facility failed to ensure orders for psychotropic drugs were limited to 14 days for 1 of 6 residents reviewed for unnecessary medications, Resident #74. Findings include: Review of Resident #74's physician order dated 1/19/2024 showed the order read, Alprazolam Oral Tablet 0.5 MG [milligrams] (Alprazolam) *Controlled Drug* Give 1 tablet by mouth every 3 hours as needed for restlessness agitation Under the care of [NAME] Program Palliative Care. Review of Resident #74's Medication Administration Record for January 2024 revealed the resident received Alprazolam Oral Tablet 0.5 MG on 1/19/2024. Review of Resident #74's Medication Administration Record for February 2024 revealed the resident received Alprazolam Oral Tablet 0.5 MG on 2/1/2024, 2/2/2024 (two doses), 2/4/2024, and 2/6/2024 (two doses). Review of Resident #74's psychiatric progress notes dated 1/19/2024 and 1/30/2024 revealed no documentation indicating the attending physician or prescribing practitioner had specified the duration of Resident #74's PRN [as needed] anti-anxiety medication. Review of Resident #74's most recent psychiatric progress notes, dated 1/30/2024 and 1/19/2024, failed to reveal documentation attending physician or prescribing practitioner had specified the duration of Resident #74's PRN antianxiety medication. During an interview on 2/7/2024 at 9:55 AM, Staff A, Licensed Practical Nurse, confirmed that Resident #74 had been prescribed with an antianxiety medication on 1/19/2024, and the resident's antianxiety medication prescription had exceeded 14 days. Review of the facility policy and procedures titled Medication Management- Psychotropic Medications last reviewed on 1/24/2024, showed the policy read, Procedure . 7. PRN physician order(s) for psychotropic medications are limited to 14 days. Except, if the physician or prescribing practitioner believes that it is appropriate to extend beyond 14 days and documents the rationale in the medical record and indicates the duration of the PRN order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 6 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure the medications and biologicals were stored and labeled properly in 4 of 7 medication carts reviewed (Photographic evidence obtained). Findings include: During an observation of Magnolia Medication Cart on 2/5/2024 at 8:57 AM with Staff B, Licensed Practical Nurse (LPN), there were one opened Humalog insulin pen with no opened or expiration dates, one opened bottle of pro-stat with no opened or expiration dates, one opened Fluticasone Furoate/Vilanterol Ellipta Inhaler with no opened or expiration dates, and one medication cup containing gold color gel capsules with no identifier. During an interview on 2/5/2024 at 9:02 AM, Staff B, LPN, stated, The insulin pen belongs to a resident that was discharged last week. The pen should have been removed from the medication cart. The medication should be labeled with the opened date when opened. The capsules are fish oil. I got them from the other medication cart. I was waiting on central supply to get a bottle. Medication should be stored in original packaging. During an observation of Split Medication Cart on 2/5/2024 at 9:07 AM with Staff D, LPN, there were one opened bottle of pro-stat with no opened or expiration dates, one opened Humulin vial with no opened or expiration dates, one opened vial of insulin Glargine-yfgn with no opened or expiration dates, one opened vial of insulin Lispro with no opened or expiration date and not stored in original packaging, and one medication cup containing two gold clear gel capsules with no identifier. During an interview on 2/5/2024 at 9:10 AM, Staff D, LPN, stated, Medication should be stored in the original packing from pharmacy. Medication should be labeled with opened and expiration dates. The capsules are fish oil. During an observation of Elm Medication Cart on 2/5/2024 at 9:15 AM with Staff E, LPN, there were one opened bottle of Latanoprost eye drop with no opened or expiration dates, one opened bottle of Ciprofloxacin eye drops with no opened or expiration dates, two opened Advair Diskus inhaler with no opened or expiration dates, one opened Breo Ellipta inhaler with no opened or expiration dates, one opened Trelegy Ellipta inhaler with no opened or expiration dates, and one opened bottle of pro-stat with no opened or expiration dates. During an interview on 2/5/2024 at 9:20 AM, Staff E, LPN, stated, All opened medications should be dated when opened. During an observation of Lake Street Medication Cart on 2/5/2024 at 9:25 AM with Staff C, LPN, there were one opened Fiasp flex insulin pen with no opened or expiration dates, one expired Basaglar kwikpen with an opened date of 12/20/2023, one opened Humalog insulin pen with no opened or expiration dates, one opened Latanoprost eye drops with no opened or expiration dates, and one expired Novolog insulin pen with an opened date of 1/1/2024. During an interview on 2/5/2024 at 9:35 AM, Staff C, LPN, stated, Expired medications should be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 7 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some removed from medication cart. When we open a medication, the medication should be labeled with opened and expiration date. During an interview on 2/7/2024 at 10:20 AM, Staff A, LPN, Unit Manager, stated, Medication should be labeled with opened and expiration date. Medication should be stored in the original pharmacy packing and expired medication should be removed from medication cart. Review of the facility policy and procedures titled Medication Storage with the last review date of 1/24/2024 showed the policy read, Procedure . E. Medications will be stored in the original, labeled containers received from the pharmacy. Review of the facility policy and procedures titled Insulin Pen Labeling & Packaging with the last review date of 1/24/2024 showed the policy read, Procedure: A. Labeling and packaging of individual Insulin Pens . 2. Insulin Pens are placed in a resealable bag with the following labels/stickers . d. A yellow Date/Expiration sticker. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 8 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure food items were dated and/or labeled, and covered, and the kitchen equipment was maintained in a clean condition. Residents Affected - Some Findings include: During an observation while conducting an initial tour of the kitchen on 2/5/2024 at 9:05 AM with the District Dietary Manager (DDM) and the Kitchen Manager, there were two pitchers containing juice in the reach-in cooler without an identifying label or date, and one medium-sized stainless steel bowl with a partial clear plastic cover with no date or identifying label that had use for puree written on the clear plastic cover. The catch tray on the gas stove had a large buildup of burnt food particles and debris spills. There was rust and food on the can opener blade and holder. There were 54 glasses of assorted drinks without an identifying label in the reach-in cooler. During an interview on 2/5/2024 at 9:12 AM, the DDM stated that all foods should have identifying labels and dates. The DDM stated that the stainless steel bowl with use for puree written on the cover should have been labeled as chicken salad and dated. The DDM also stated that the catch tray on the stove should have been cleaned weekly and it had a lot of buildup and had not been cleaned. During the follow-up visit to the kitchen on 2/6/2024 at 6:25 AM with the DDM, there were six vanilla health shakes with no pulled or use-by dates, one opened gallon container of milk with no opened date, and nine swirl bowls of a fruit type dessert leftover with no identifying label or date. During an observation on 2/6/2024 at 6:57 AM, a robot coupe machine used to prepare ground, pureed, and chopped foods was stored with water in the base and not stored to allow the equipment to air dry. During an interview on 2/6/2024 at 6:57 AM, the Morning [NAME] stated the robot coupe was clean and ready to use. During an interview on 2/6/2024 at 7:00 AM, the DDM stated all products should be labeled and dated when opened including leftover foods, and the equipment should be cleaned and stored properly. The DDM stated the supplements should have a pulled to thaw date and a use by date. During an observation while conducting a tour of the nourishment rooms with the Dietary Supervisor (DS) on 2/7/2024 at 6:47 AM, there were seven assorted sandwiches with no identifying label in Unit One Nourishment Room and eleven sandwiches with no identifying label in Unit Two Nourishment Room. The microwave oven in Unit Two Nourishment Room had a large amount of food spatter on the inner top of the microwave oven. During an interview on 2/7/2024 at 6:55 AM, the DS stated that all food items should be identified, and refrigerators and microwave ovens should be cleaned according to the cleaning of equipment policy. Review of the facility policy and procedures titled Food Storage: Cold Foods last reviewed on 1/24/2024 showed the policy read, Procedures . 5. All foods will be stored wrapped or in covered containers, labeled and dated, and arranged in a manner to prevent cross contamination. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 9 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the facility policy and procedure titled Manual Warewashing last reviewed on 1/24/2024 showed the policy read, Procedure . 3. All serviceware and cookware will be air dried prior to storage. Review of the facility policy and procedures titled Equipment last reviewed on 1/24/2024 showed the policy read, Procedures: 1. All equipment will be routinely cleaned and maintained in accordance with the manufacturer's directions and training materials. Event ID: Facility ID: 105996 If continuation sheet Page 10 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and interview, the facility failed to ensure staff performed hand hygiene during tracheostomy care for 1 of 1 resident reviewed for tracheostomy care, Resident #32, and during medication administration for 2 of 6 residents reviewed for medication administration, Residents #74 and #69, to prevent possible spread of infection and communicable diseases. Residents Affected - Few Findings include: 1. Review of Resident #32's physician order dated 10/13/2022 read, Change trach [Tracheostomy] q [every] 30 days. Review of Resident #32's physician order dated 9/18/2019 read, Tracheostomy- Access skin around stoma site and under ties during trach care. During an observation on 2/7/2024 at 11:40 AM, Staff F, License Practical Nurse (LPN), removed Resident #32's oxygen mask, inner cannula, and gauze from the tracheostomy site. Staff F removed her surgical gloves and without performing hand hygiene proceeded to open the sterile tracheostomy kit. Staff F donned new sterile gloves and started to clean the tracheostomy plate and surrounding areas. Without changing gloves or performing hand hygiene, Staff F proceeded to open a new inner cannula and placed the inner cannula into the outer cannula with the same gloves she used to clean the tracheostomy site. Staff F touched the inner cannula portion that would be inserted into the stoma. Review of the facility policy and procedure tilted Tracheostomy Care with the last review date of 1/24/2024 showed the policy read, For tracheostomy with disposable inner canula . Remove your gloves and discard into a waster container . Perform Hand Hygiene. Review of the facility policy and procedures tilted Hand Hygiene with the last review date of 1/24/2024 showed the policy read, Process: Hand hygiene should be performed . When hands are moved from a contaminated-body site to a clean body site during patient care. Review of the facility's skills competency assessment for tracheostomy care dated 10/2021 showed the assessment read, The employee demonstrates skills and competence in the following . Wash hands and apply gloves (soap and water or hand sanitizer). Clean work surface and cover with non-permeable barrier. Remove gloves, discard. Perform hand hygiene. During an interview on 2/7/2024 at 12:30 PM, Staff A, LPN, Unit Manager, stated, [Staff F's name] did not practice sterile techniques and should have washed her hands when changing gloves during the tracheostomy care. 2. During an observation on 2/7/2024 at 8:46 AM, Staff F, LPN, started preparing medications for Resident #74 at the medication cart without performing hand hygiene. Staff F entered the resident's room and washed her hands and took Resident #74's blood pressure with a small wrist blood pressure cuff. Staff F exited the room and returned to the medication cart. Staff F did not perform hand hygiene. Staff F retrieved blood pressure medication and entered Resident #74's room and handed a cup and water to the resident. Resident #74 spit out the medication and refused to take medications. Staff F returned to the medication cart and started preparing medications for Resident #69 without performing hand hygiene. Staff F grabbed the blood pressure cuff without sanitizing it in between residents and entered Resident #69's room. Staff F washed her hands after entering the resident's room. Staff F (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 11 of 12 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 105996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Spring Hill 12170 Cortez Blvd Brooksville, FL 34613 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few took the resident's blood pressure and exited the room. Staff F returned to the medication cart and retrieved blood pressure medication without performing hand hygiene. Staff F entered Resident #69's room and administered all medications to Resident #69. Staff F exited the resident's room and returned to the medication cart and opened a new resident record without performing hand hygiene. During an interview on 2/7/2024 at 9:17 AM, Staff F, LPN, stated, I should have washed my hands more in between residents. I know you sanitize the blood sugar machine, but I did not know we had to sanitize the blood pressure machine. During an interview on 2/7/2024 at 9:20 AM, Staff A, LPN, Unit Manager, stated, The nurse should have washed her hands in between resident interaction and sanitized her blood pressure cuff between resident use. During an interview on 2/7/2024 at 1:10 PM, the Infection Preventionist stated, The nurse should have sanitized the blood cuff in between resident use. It is considered a reusable item. Review of the facility policy and procedures titled Handwashing with the last review date of 1/24/2024 showed the policy read, Policy: An essential component of infection control is hand washing. All staff members must wash their hands. Review of the facility policy and procedures titled Cleaning and Disinfection of Resident-Care Items and Equipment with the last review date of 1/24/2024 showed the policy read, Policy Statement: Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OSHA Bloodborne Pathogens Standards. Policy Interpretation and Implementation . d. Reusable items are cleaned and disinfected or sterilized between residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105996 If continuation sheet Page 12 of 12