Health inspection·October 26, 2023

F 0679 Provide activities to meet all resident's needs. 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 an individualized activity program based on preferences and plan of care was provided for 1 of 2 dependent residents reviewed for Activities, of a total sample of 44 residents, (#73). Residents Affected - Few Findings: Resident #73 was admitted to the facility on [DATE], with her most recent readmission on [DATE]. Her diagnoses included Alzheimer's disease, generalized muscle weakness, symptoms and anxiety disorder. Review of the significant change Minimum Data Set (MDS) assessment, with Assessment Reference Date of 9/18/23, revealed the resident was rarely/never understood. The assessment noted daily and activity preferences indicated the resident liked listening to music, doing things with groups of people, and participating in favorite activities. Review of the Psychosocial Evaluation conducted on 4/01/22, revealed the resident preferred one on one, and small group activities. Her current interest included animals/pet, music, and television on Spanish channels. Documentation read, will receive 1:1 visits as tolerated. She enjoys watching Spanish TV channels, nail spa, listen to Spanish music, and hand massage. Observations on 10/23/23 at 11:24 AM, at 12:40 PM, at 3:49 PM, and on 10/25/23 at 10:15 AM, resident #73 was lying in bed on her back. She did not respond when spoken to, and no form of activities was noted. The television was not on, and no music was being played. On 10/25/23 at 10:22 AM, the Director of Activities stated that bird therapy, and room visits were provided by the Activity Department for dependent residents. He stated resident #73 did not do much but liked to listen to music. The Director of Activities stated the Activities Assistant documented on the Activity Log when room visits were made. Review of the Activity log for the period 9/15/23 to current revealed no documentation to indicate room visits or any form of activities were provided for resident #73. This was confirmed by the Director of Activities. On 10/25/23 at 10:30 AM, the Activities Assistant stated that in the morning, she went room to room, provided ice, and friendly visits to residents, and documented the interaction on the activity log. She stated she had done room visits with resident #73 but forgot to document the visits in the Activity Log. On 10/25/23 at 10:43 AM, Certified Nursing Assistant (CNA) B, stated resident #73 required total Page 1 of 4 106074 106074 10/26/2023 Aviata at Kissimmee Gardens 1120 W Donegan Ave Kissimmee, FL 34741

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few care for all her activities of daily living, and was on hospice services. CNA B stated the resident was confused, and activities were not provided for her. On 10/25/23 at 3:37 PM, the resident's Psychosocial evaluation, assessment of Section F of the resident's MDS, and interventions documented in the resident's care plan for activities was shared with the Activities Director. He stated he did not know what the resident required and had not reviewed the resident's Psychosocial evaluation or care plan. He verbalized he focused on residents admitted to the facility since he was hired. The Activities Director confirmed the resident's name was not on the activity log for 1 on 1 visits, and said he needed to work on understanding what each resident needed for their day-to-day activities. The resident's care plan noted she was dependent on staff for meeting emotional, intellectual, physical, and social needs related to cognitive deficits, and physical limitations was initiated on 4/11/22, and revised on 10/11/22. The goal noted the resident was to receive 1 on 1 visits as tolerated through the next review date. Interventions included, 1 on 1 visits as tolerated, enjoys watching Spanish TV channels, listen to Spanish music, hand massage, and needs bedside/in room visits and activities if unable to attend out of room events. The facility's policy Community Life Overview with effective date of 11/01/2021 read, Activity programs are developed and implemented to meet the individualized physical, mental, and psychosocial/emotional needs of the resident. The procedure indicated the facility should identify activities and programming of interest to the resident, and Document resident participation. 106074 Page 2 of 4 106074 10/26/2023 Aviata at Kissimmee Gardens 1120 W Donegan Ave Kissimmee, FL 34741

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. 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 a Midline intravenous dressing was changed in accordance with professional standards to prevent the potential for infection for 1 of 1 resident reviewed of a total sample of 44 residents, (#152). Residents Affected - Few Findings: Resident #152, an 84- year-old male was admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included aphasia, occlusion and stenosis of unspecified cerebral artery, [NAME] fever, chronic obstructive pulmonary disease, heart failure, gastrostomy, and atrial fibrillation. Review of the Medical Certification for Medicaid Long-Term Care Services And Patient Transfer Form (3008) dated 10/16/23 revealed the resident's primary diagnosis was sepsis, and acute kidney injury. Documentation indicated the resident was alert, disoriented, could not follow simple instructions, and had a Midline that was inserted on 10/12/23. A midline . is a long, thin, flexible tube that is inserted into a large vein in the upper arm. It is used to safely administer medication into the bloodstream. (retrieved on 11/02/23 from www.uhs.nhs.uk). On 10/24/23 at 3:25 PM, resident #152 was lying in bed on his back. He was unable to answer questions. A Midline was noted to the resident's left upper arm. The midline dressing was lifting at the edges, and the dressing was dated 10/14/23. On 10/24/23 at 3:28 PM, observation of the resident's midline was conducted with the Director of Nursing (DON). He confirmed the date on the dressing was 10/14/23 and stated midline dressings should be changed every seven days, and resident #152's dressing should have been changed on 10/21/23. Review of the resident's physician orders revealed no order for dressing changes, or flushes for the resident's midline. The DON verbalized the resident was admitted to the facility from an acute care hospital on [DATE] with a midline that was inserted on 10/12/23. He stated the protocol was for the nurse to review the admitting orders with the physician, make the physician aware of the midline, and obtain an order for the midline dressing to be changed, flushed, or discontinued if not in use. The DON said the midline dressing was to be changed on admission, and then every seven days. On 10/24/23 at 3:32 PM, the resident's primary nurse, Registered Nurse (RN) C stated he observed the midline to the resident's left upper arm this morning but did not note the date on the dressing. He stated he was aware midline dressings should be changed every seven days. He reviewed the resident's clinical records and confirmed that a physician's order for the midline was not identified. The facility's policy for Midline Catheter Dressing Change with revision date of 2/2018 read, The catheter insertion site is a potential entry site for bacteria that may cause a catheter-related infection . Sterile dressing change using transparent dressings is performed upon admission. if transparent dressing is dated, clean, dry, and intact, the admission dressing change may be omitted and scheduled for 7 days from the date on the dressing label. 106074 Page 3 of 4 106074 10/26/2023 Aviata at Kissimmee Gardens 1120 W Donegan Ave Kissimmee, FL 34741

F 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure binding arbitration agreements explicitly granted the resident or their representative the right to rescind the contract within 30 calendar days of signing for 2 of 3 residents reviewed for arbitration agreements, (#202, #250). Residents Affected - Many Findings: 1. Resident #202 was admitted to the facility on [DATE] and signed the Optional Arbitration Agreement (form revised 4/17) on 10/18/23. The agreement read, It is understood by Resident that he or she is not required to use this Facility .It is further understood that the Agreement to Arbitrate is a separate and stand-alone contract from the admission Agreement The agreement did not include option to rescind the agreement within 30 calendar days of signing. 2. Resident #250 was admitted to the facility on [DATE] and signed the Optional Arbitration Agreement (form revised 4/17) on 10/17/23 which did not include option to rescind the agreement. On 10/26/23 at 1:18 PM, the Admissions Director said she was responsible for getting the new admission paperwork signed by the resident or their representative which included the Optional Arbitration Agreement. The admission Director acknowledged she was not aware of the federal regulatory requirement of giving residents or their representative 30 days to rescind the agreement. 106074 Page 4 of 4