Bradenton Health Care

F-F600.

Review of the facility's plan of correction for the survey ending 7/12/24 with a completion date of 8/11/24 revealed the following measures would be taken to correct the deficient practice which was identified at

F-F684.

Review of the facility's plan of correction for the survey ending 7/12/24 with a completion date of 8/11/24 revealed the following measures would be taken to correct the deficient practice which was identified at

F-F726.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 15 106017 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 106017 B. Wing 07/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Aviata at Palma Sola Bay 6305 Cortez Rd W Bradenton, FL 34210

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 0867 Review of the facility's plan of correction for the survey ending 7/12/24 with a completion date of 8/11/24 revealed the following measures would be taken to correct the deficient practice which was identified at Level of Harm - Minimal harm or

F-F880.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 15 106017 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 106017 B. Wing 07/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Aviata at Palma Sola Bay 6305 Cortez Rd W Bradenton, FL 34210

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 49497 potential for actual harm Based on observations, record review, and interviews, the facility failed to maintain and implement an Residents Affected - Few effective infection prevention and control program designed to provide a safe, sanitary, and comfortable environment, to prevent the development and transmission of communicable diseases and infections as evidenced by a lack of enhanced barrier precaution signage on doors of two residents (#81, #297) out of 20 residents on enhanced barrier precautions.

Findings included:

1. On 07/08/24 at 1:00pm observed Resident #297 IV (intravenous) port and dressing to right upper arm. Observed no enhanced barrier precaution sign on door and no storage bin outside of Resident #297 door with personal protective equipment (PPE) supplies.

On 07/11/24 at 8:52 a.m. observed Resident #297 door with no enhanced barrier precaution signage or storage bin with PPE supplies located outside of door. Photo evidence obtained.

Review of electronic medical record (EMR) for Resident #297 showed an admitted [DATE REDACTED] with included diagnoses of encephalopathy, acute and subacute infective endocarditis, presence of artificial heart valve, arteriovenous malformation site unspecified, atherosclerosis of coronary artery bypass graft(s) without angina pectoris. Review of code status showed resident listed as a full code.

Review of the Minimum Data Set (MDS) for Resident #297, dated 07/06/24, revealed a Brief Interview for Mental Status (BIMS) score of 15, indicating no cognitive impairment.

A review of the 3008 form, dated 07/05/24, revealed:

- Comments section Daptomycin 300 mg IV daily. Duration 6-8 weeks.

- Treatment devices, right PICC (peripherally inserted central catheter) inserted 06/21/24.

Review of the physician orders revealed:

- Return IV pump to pharmacy following IV therapy

-Change dressing on admission or 24 hours after insertion and weekly thereafter and PRN

-IVs: Type of access: midline.

- IVs: Flush PICC or Midline with 10 mls of normal saline every shift and as needed.

- Infectious disease appt 07/12/24 at 2:00 p.m.

A review of the care plan for Resident #297, dated 07/06/24, revealed the following:

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 15 106017 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 106017 B. Wing 07/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Aviata at Palma Sola Bay 6305 Cortez Rd W Bradenton, FL 34210

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 -A focus of The resident requires enhanced barrier precautions related to use of indwelling medical device IV PICC and is at risk for a CDC MDRO infection. Date initiated 07/08/2024. With intervention, Signage at Level of Harm - Minimal harm or designated area to alert staff and visitor of enhanced barrier precautions. Date initiated: 07/08/24. potential for actual harm - A focus of The resident is on IV Medications r/t [related to] Endocarditis. Date Initiated: 07/06/24. With a Residents Affected - Few goal of The resident will have not have [will not have] any complications related to IV Therapy through the

review date. Date Initiated: 07/06/2024, Target Date: 10/04/2024.

A review of the medical record for Resident #297 on 07/08/24 showed no physician order for enhanced barrier precaution.

Review of the facility matrix revealed 20 residents are marked for enhanced barrier precautions. Resident #297 was not listed on facility matrix for enhanced barrier precautions.

2. On 07/09/24 at 8:48 a.m., observed Resident #81's door with no enhanced barrier precaution signage on door.

On 7/11/24 at 8:55 a.m. observed no enhance barrier precaution signage on Resident #81 door.

Review of the medical record for Resident #81 showed an admission to facility on 03/02/24 with diagnoses that included osteomyelitis of vertebra, sacral and sacrococcygeal region, quadriplegia, methicillin resistant staphylococcus aureus infection as the cause of diseases classified elsewhere, unspecified psychosis not due to a substance or known physiological condition, major depressive disorder, malignant neoplasm of unspecified site of unspecified breast, colostomy status, presence of urogenital implants. Review of code status showed resident listed as do not resuscitate (DNR).

A review of the Physician orders revealed:

-03/02/24 PEG Tube, catheter and colostomy.

-07/09/24 Enhance Barrier Precautions related to percutaneous endoscopic gastrostomy (PEG) Tube, Foley catheter and colostomy.

A review of the care plan, dated 06/03/24, revealed:

- A focus of enhanced barrier precautions related to use of indwelling medical device Foley Catheter, Peg tube, Colostomy and is at risk for a CDC MDRO infection. Date initiated 07/09/24. Interventions included Signage at designated area to alert staff and visitor of enhanced barrier precautions. Date initiated 07/09/24.

- A focus of the resident requires enhanced barrier precautions related to chronic wounds requiring dressing/covering and is at risk for a CDC MDRO infection dated 07/09/24. With interventions that include education of need for enhanced barrier precaution provided to resident/family/caregivers. and signage at designated area to alert staff and visitor of enhanced barrier precautions. date initiated 07/09/24.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 15 106017 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 106017 B. Wing 07/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Aviata at Palma Sola Bay 6305 Cortez Rd W Bradenton, FL 34210

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 An interview was conducted on 07/11/24 at 1:47 p.m. with Staff E, Certified Nursing Assistant (CNA). She stated for any resident on infection precautions she is made aware by the signage on the door. She follows Level of Harm - Minimal harm or what the sign says, If it says gown and mask, I put on gown and mask before going in the room and take off potential for actual harm and put in wastebasket before coming out to the hall.

Residents Affected - Few An interview was conducted on 07/11/24 at 1:51 p.m. with Staff D, Housekeeper. She stated, she knows when to wear PPE in a residents room by I follow signs on door and pointed to enhanced barrier precaution sign on a resident's door.

An interview was conducted on 07/11/24 at 1:55 p.m. with Staff B, Physical Therapy Assistant. She stated

she goes by the sign on resident's door and what is in a residents therapy evaluation to determine if a patient is on precautions before entering the room, to know what type of PPE is necessary.

An interview was conducted on 07/11/24 at 2:10 p.m. with Staff A, Licensed Practical Nurse. She stated the residents should have a precaution sign on their door and plastic bin with proper PPE supplies. She stated

they can look in medical record under resident medication administration record (MAR) and they should have

a physician order for precautions. She stated enhanced precautions are for residents with Wound, intravenous therapy (IV), Foley etc. She stated PPE for enhanced precautions are gown, gloves and mask to be worn when entering room for staff providing direct care to resident. Hand washing for visitors or staff if no direct care is provided. She stated Staff C, Assistant Director of Nursing is the infection preventionist and is

in charge of putting up and taking down all infection precaution signs. She stated if she is not available the nurse in charge of the resident would be responsible.

An interview was conducted on 07/11/24 at 3:00 p.m. with Staff C, Infection Preventionist. She stated the three types of precautions followed are droplet, contact and enhanced barrier at the facility. She stated enhanced precautions require gloves, gowns and masks for staff who are providing direct patient care. Any resident with an indwelling medical device such as Foley's, IV's, PEG tubes, nephropathies, wound vac would be placed on enhanced precautions. She stated she would put signage on the door and get a bin of PPE when a confirmed resident is on any type of precaution. She stated currently they have bins ordered so

they are being shared on the hallway till new ones arrive. She stated the resident would need to have an order in the EMR for a type of isolation or precaution. She stated if she is off work or resident admits over the weekend, the Director of Nursing (DON) or unit manager would be expected to hang signage and place PPE bin outside the door and ensure physician order is placed in the chart and relay information to hall nurse.

She reviewed Resident #297's medical record and stated She has an order for enhanced precautions. It should have started when she was admitted on [DATE REDACTED]. She stated, She has an IV so she automatically should be on enhanced precautions. She stated she would expect the DON or Unit Manager to complete PPE signage and bin for new resident as she is off when resident admitted . She stated, that's my mistake,

the enhanced precautions sign should have been on the door (referring to Resident #297). She stated is should have been placed on day of admission because the resident was admitted with the IV.

When questioned why Resident #81 did not have enhanced precaution signage on the door. She stated she should have been placed on enhanced precaution on 5/4/24 because of her Foley, peg tube and colostomy.

She stated it was her mistake, I missed it. She stated the order in the chart for enhanced should have started

on 05/04/24, the current order started on 07/09/24. She stated, We didn't catch it.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 15 106017 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 106017 B. Wing 07/12/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Aviata at Palma Sola Bay 6305 Cortez Rd W Bradenton, FL 34210

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 Review of facility policy for enhanced barrier precautions, dated August 2022, revealed the policy interpretation and implementation included: Level of Harm - Minimal harm or potential for actual harm -#5 Enhanced barrier precautions (EBP) are indicated for resident with wounds and/or indwelling medical devices regardless of multidrug resistance organism (MDRO) colonization. Residents Affected - Few -#10 Signs are posted in the door or wall outside the resident room indicating the type of precautions and PPE required.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 15 106017