Inspection·January 14, 2021

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to update care plans and ensure care plan approaches were measurable for 1 of 4 sampled residents at risk for falls (#16). Findings: On 1/11/21 at 11:10 AM, resident #16 was observed in his room. The resident was in a low bed with mats around the bed. The resident was confused and there was no music or television on in the room for the resident. A review of the resident's medical record revealed that resident #16 was admitted to the facility on [DATE]. His diagnoses included Adult Failure to Thrive, Diabetes, Dementia and Metabolic Encephalopathy. The 14 day Minimum Data Set assessment noted a Brief Interview for Mental Status of 4 that indicated the resident's cognition was severely impaired. He required extensive assistance for Activities of Daily Living that included bed mobility and transfers. The Care Area Assessment noted the resident was at risk for falls and that a fall care plan would be developed The initial approaches on the fall care plan, dated 10/28/20, included the following: *Encourage patient to use call light for assistance as needed. *Fall Risk assessment quarterly and as needed. *Maintain call light within reach. *Provide education to patient/family on fall risk strategies and interventions available. *Physical and Occupational Therapy services to evaluate and treat as needed An Exception Report dated 11/19/20 at 12:30 AM noted, CNA (Certified Nursing Assistant) heard resident yelling help, summoned nurse to room, found resident laying on his left side on an incontinent pad on the floor to left of bed with no clothes on. Resident stated he lost footing and laid on floor does not remember anything else about the incident. No injuries Staff noted towards the end of the Exception Report the Immediate New Measures, implemented included low bed, mats on floor beside bed and frequent checks while restless. The frequent checks did not have defined time frames and were not measurable. Another Exception Report dated 11/19/20 at 7:00 AM read, CNA informed nurse when she checked (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 2 Event ID: 106123 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 106123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive 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)