Aviata At Harts Harbor
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm
interventions based on Patient/Residents' risk. Document individualized interventions in the patient/resident Care Plan and Kardex. If utilizing a wander monitoring system device check placement of the device every shift and functionality every day.Maintain the Elopement Risk Alerts in an easily accessible location.
Complete routine elopement drills monthly and review in QAPI meeting. QAPI: Review trends of elopement drills by the QAPI team.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
10/22/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aviata at Harts Harbor
11565 Harts Rd Jacksonville, FL 32218
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-Tag F0867
F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
wandering behaviors noted.Care plan revised on 1/19/22 indicated that Resident #3 is an elopement risk/wanderer- wander guard in place to right ankle. exp Feb. 2026.Quarterly MDS ARD 7/26/25 - BIMS 15 No wandering (Care plan was not updated).During an interview with Employe C Certified Nurse Assistant (CNA) on 10/22/25 at 4:35 pm, she stated that she had worked in the facility for almost 20 years and was familiar with Resident #3. She stated that Resident #3 was independent with her care alert and oriented and able to make needs know. She stated that resident had no exit seeking behaviors.During interview with
the Administrator on 10/22/25 at 5:29 pm, he stated that he coordinated QAPI. When asked how he ensured that the plan identified in the PIP was followed. He stated that PIP is discussed during clinical meeting conducted daily. He stated that the Elopement PIP was still ongoing and the facility was still conducing audits and training. When asked for the weekly audits of residents at risk for elopement & elopement books, he stated that the DON was responsible to conduct the audit he confirmed that there were only three audits (Copies obtained). He stated that he did not review the audits during the September QAPI.Reviewed facility policy and procedure titled Quality Assurance Performance Improvement Program (QAPI) Document Name: PI-215 revised 10/24/25, revealed the following:Page 6: Performance Improvement Projects: The center utilizes performance improvement projects to improve a systemic problem or improve quality in absence of a problem. Performance Improvement Projects (PIPs) are based
on the centers services and resources identified in the Facility Assessment. At a minimum, the center must conduct one performance improvement project annually. a. The PIP should focus on high-risk or problem prone areas, identified by the center.b. The team may consist of one or more team membersc. The team will complete the following functions: i. Collect and analyze data. ii. Determine Root Cause. iii. Determine steps for resolution.iv. Implement corrective action.v. Evaluate effectiveness of the actions.vi. Report progress to QAPI committee.
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Facility ID:
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AVIATA AT HARTS HARBOR in JACKSONVILLE, FL inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in JACKSONVILLE, FL, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from AVIATA AT HARTS HARBOR or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.