Below average — CMS composite of the measures below.
A standard survey is most likely before around November 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Aviata At South Daytona during CMS and state inspections, most recent first.
A resident with cerebral palsy and dependence for transfers had a care plan requiring a Hoyer lift and two staff for all transfers, but a CNA attempted a manual stand-and-pivot transfer instead. During the transfer, the resident’s weight shifted, she was guided to the floor, and she later reported being dropped and injured. Hospital imaging confirmed fractures of the distal femur and patella, and staff interviews confirmed the resident’s transfer status required a lift with two-person assistance.
A CNA attempted to transfer a resident using a manual pivot instead of the resident’s required Hoyer lift with two staff assist. The resident’s weight shifted during the transfer, she was lowered to the floor, and she later reported that she was dropped and fell with her leg caught underneath her. The resident, who had cerebral palsy and was dependent for transfers, was later found to have fractures of the lower R femur and patella. An LPN nearby heard the CNA call for help, and the CNA did not report the fall.
Poor Room Maintenance and Unaddressed Bathroom Leak: The facility failed to maintain several resident rooms in a clean, comfortable, and homelike condition. A resident room had a broken window covered with wood and duct tape, another had missing drywall and chipped paint, and another had a missing AC control knob, rotting wood, and damaged paint; daily angel rounds still marked these areas as in good repair. A resident’s bathroom also had heavy staining, leaking pipes, pooled water, soaked linen, and an odor, and the resident said the flooding had been present for at least six days.
Failure to log refrigerator temperatures for the main nursing station nourishment refrigerator was identified during a tour. The unit stored med pass supplements and applesauce for residents, but August temperature documentation was missing. Staff gave conflicting answers about whether nursing, dietary, or the dietary aide was responsible for the logs, and the facility policy required daily written temperature records for cold foods.
Pharmacist medication regimen reviews were not carried out as documented for two residents receiving psychotropic and other medications. One resident had orders for antidepressants, a diuretic, and anticoagulation therapy, with care plan interventions for behavior and side effect monitoring, but an LPN confirmed there was no TAR documentation for behaviors or diuretic monitoring. Another resident with severe cognitive impairment had orders for Depakote, Trazodone, Mirtazapine, and Lorazepam, and the consultant pharmacist repeatedly requested behavior monitoring on the eMAR, but an LPN confirmed no documented monitoring for Trazodone and Depakote.
Staff failed to follow the IPCP for a resident with COVID-19. A CNA entered the resident’s room wearing only a surgical mask instead of the required PPE, and another CNA later transported the resident to the dining/activities room without a mask, where he sat near eight other residents. The IP/RN and interim DON stated COVID-19-positive residents must remain isolated for 10 days unless medically necessary and must wear a mask if leaving the room; the facility policy required N95 or higher respirator, gown, gloves, and eye protection for care.
Call lights were not kept within reach for three residents while they were in bed. One resident had moderate cognitive impairment, toileting assistance needs, and incontinence, and his care plan directed staff to keep the call light within reach. Another resident had intact cognition but his call light was under the bed, and a third resident was observed asleep with her call light underneath the bed and not accessible. The DON stated the call bell was the device used to alert staff and that ensuring it was within reach was everybody’s responsibility.
Failure to Follow Required Transfer Assistance
Penalty
Summary
The facility failed to protect a resident from neglect by not ensuring that staff followed the resident’s care plan for transfers. The resident had cerebral palsy and was documented as dependent for toileting hygiene, bed mobility, and transfers. Her active care plan required all care to be provided by two staff, extensive assist of two staff for bed mobility, and use of a Hoyer lift with two staff assistance for transfers. Her quarterly MDS also reflected intact cognition with a BIMS score of 14 out of 15. On the day of the incident, a CNA attempted to transfer the resident from bed to chair using a manual stand-and-pivot method instead of the required mechanical lift and two-person assistance. The CNA stated she could not find the Hoyer pad or sit-to-stand lift and, based on prior experience, proceeded with a manual pivot transfer. During the transfer, the resident’s weight shifted and the CNA guided her to the floor. The CNA later reported that she and another staff member were unable to complete the lift with two people and needed a third coworker to help place the resident into the chair. The resident later reported that the CNA wrapped her arms around her body, lifted her, could not hold on, and dropped her, then dropped her again when trying to help her back up. She stated her leg was caught underneath her and she ended up with a break. Hospital records showed she was admitted with knee pain after staff at the facility were trying to transfer her but were unable to support her weight, causing her to fall onto her knee. Imaging confirmed fractures of the distal right femur and right patella. Interviews with nursing staff confirmed the resident’s transfer status required a lift and two staff, and that the CNA had not followed the care plan during the transfer.
Unsafe Transfer Resulted in Resident Fall and Fractures
Penalty
Summary
The facility failed to implement the resident’s care plan for transfers when a CNA attempted to move the resident from bed to chair using a stand-and-pivot method instead of the required Hoyer lift with two staff assistance. The resident’s active care plan, revised on 4/8/2026, specified that all care was to be provided by two staff, that bed mobility required extensive assist of two staff, and that transfers required a Hoyer lift with two staff assistance. The resident’s quarterly MDS assessment showed dependence with toileting hygiene, bed mobility, and transfers, and the resident had a BIMS score of 14 out of 15, indicating intact cognition. On the morning of the incident, the CNA reported that she could not find the Hoyer pad or a sit-to-stand lift and, based on prior experience with the resident, proceeded with a manual pivot transfer. During the transfer, the resident’s weight shifted and the CNA guided the resident to the floor. The CNA later stated she did not allow the resident to fall and that the resident did not express pain or distress during or immediately after the event. An LPN who was nearby stated he heard the CNA call for help and saw the CNA holding the resident up on the side of the bed as the resident was slipping down, with the resident’s feet on the floor. After the event, the resident reported that the CNA had wrapped her arms around her body, that the CNA could not hold on, and that she was dropped and fell with her leg caught underneath her. The resident was later found to have fractures of the lower right femur and right patella. The resident’s medical history included cerebral palsy, and the hospital paperwork stated the resident fell while staff were trying to transfer her but were unable to support her weight. The facility’s investigation also documented that the CNA did not report the fall.
Poor Room Maintenance and Unaddressed Bathroom Leak
Penalty
Summary
The facility failed to ensure a clean, comfortable, and homelike environment in four resident rooms. During observations, room #7 had a bottom window portion missing and covered with a large piece of wood and duct tape, room #8 had missing drywall and chipped paint, and room #12 had a wall unit air conditioner missing the control knob with a 3-foot by 2-foot area of chipped and bubbling paint, rotting wood and chipped paint on the door frame near the bathroom, and several baseboards missing paint. These conditions were observed again on a second round of observations, and the Maintenance Director later verified the conditions in rooms #7, #8, and #12. A review of the prior three months of TELS maintenance work orders showed no documentation for repairs related to the broken window, bathroom door frames, baseboards, or chipped paint in the affected rooms. Facility daily angel rounds documented rooms #7, #8, and #12 as meeting requirements for walls in good repair and floors free of holes, tears, or stains, despite the observed damage. Staff interviews indicated that environmental concerns were supposed to be reported through Relias, verbal notification to the Maintenance Director, or TELS work orders, and the Maintenance Director stated there was no specific plan or calendar for room repairs. Resident #59’s bathroom was also observed with no paper towels, heavily stained floor tile, unattached tiles and grout above the sink, a leaking pipe under the sink with a trash container catching water, pooled water at the bathroom threshold, and an unpleasant odor. On a later observation, the bathroom still had the same stained tile, unattached tiles and grout, leaking pipe, soaked bed linen on the floor, pooled water at the threshold, and an unpleasant odor. The resident stated the bathroom floor had been flooding for at least six days. The Maintenance Director acknowledged the sink pipes were leaking and stated a plumber was making repairs, while also stating that the facility used daily angel rounds and TELS for identifying needed repairs, although the angel rounds provided did not identify the bathroom repairs needed in this room.
Failure to Log Refrigerator Temperatures for Resident Supplements
Penalty
Summary
The facility failed to properly monitor and log temperatures for the refrigerator at the main nursing station where resident supplements were stored. During a follow-up tour on 08/13/2025 at 11:05 AM, it was observed that temperature documentation was missing for August 2025, and photographic evidence was obtained. The refrigerator at the main nursing station was used to store med pass supplements and applesauce for residents. Interviews showed conflicting understanding of who was responsible for the temperature logs. The RN/Infection Preventionist stated nursing was responsible for logging the temperatures, while a Cook/Aide stated the CDM was responsible. Another staff member stated the dietary aide was responsible. The CDM confirmed that snacks were prepared and transported to residents, supplements were stored in an ice bath on the cart, and med pass supplements and applesauce were stored in the mini refrigerator at the main nursing station. The facility policy required an accurate thermometer in each refrigerator and freezer and a written record of daily temperatures.
Pharmacist Medication Regimen Reviews Not Followed for Behavior Monitoring
Penalty
Summary
The facility failed to ensure that monthly pharmacist medication regimen reviews were maintained and carried out in accordance with the facility’s policies and procedures for two residents. The consultant pharmacist repeatedly documented recommendations for behavior monitoring to be added to the eMAR for residents receiving psychotropic medications, including Trazodone, Sertraline/Zoloft, Depakote, Ativan/Lorazepam, and Mirtazapine, but the record review and staff interviews showed that the monitoring was not documented as required. For one resident, the chart showed active orders for Trazodone, Sertraline, Eliquis, Lasix, and Spironolactone, with diagnoses including generalized anxiety disorder, coagulation deficit, and major depressive disorder. The quarterly MDS showed antidepressant use and intact cognition with a BIMS score of 15/15. The care plan included monitoring for behaviors and side effects. During interview, an LPN confirmed the resident was receiving Trazodone, Zoloft/Sertraline, Lasix, and Spironolactone, stated behavior monitoring was documented by observing behavior, and acknowledged there was no documentation on the TAR for resident behaviors and no documentation of monitoring for diuretic use. For the second resident, the chart showed orders for Depakote, Trazodone, Mirtazapine, and Lorazepam, along with side effect monitoring orders for Mirtazapine and Lorazepam. Diagnoses included major depressive disorder, persistent mood disorder, generalized anxiety disorder, and unspecified dementia with mood disturbance, and the quarterly MDS showed severe cognitive impairment with a BIMS score of 4/15. The care plan included monitoring and documenting side effects and effectiveness. The consultant pharmacist repeatedly recommended behavior monitoring on the eMAR for the resident’s psychotropic medications, but during interview an LPN confirmed there was no documented monitoring for Trazodone and Depakote.
Failure to Follow COVID-19 Isolation and PPE Requirements
Penalty
Summary
The facility failed to ensure staff followed its infection prevention and control program and isolation precautions for a resident who was positive for COVID-19. During an outbreak in which 6 of 59 residents were COVID-19 positive, a CNA was observed exiting the resident’s room wearing only a surgical mask, despite droplet precaution signage and a stocked PPE cart outside the room. The CNA stated she entered the room to help the resident turn on a movie on his phone and acknowledged she should have worn a gown, N95 mask, and gloves. Later the same day, another CNA was observed transferring the COVID-19-positive resident in a Geri chair from his room to the common dining/activities room without a mask. The resident was then observed in the dining/activities room without a mask and in close proximity to eight other residents. When interviewed, the CNA stated she did not place a mask on the resident because he did not like wearing one and said she moved him to the dining/activities area because he was at risk for falls and staff could keep a close eye on him. The Infection Preventionist and RN reported that residents positive for COVID-19 must be quarantined in their rooms for 10 days and are not permitted to leave unless medically necessary, and if they do leave, they must wear a mask. The resident stated he knew he should be wearing a mask and asked for one. The facility’s COVID-19 policy required residents with COVID-19 to be placed in a single room when possible, staff to use an N95 or higher respirator, gown, gloves, and eye protection, and movement outside the room to be limited to medically essential needs.
Call Lights Not Within Reach of Residents in Bed
Penalty
Summary
The facility failed to ensure that residents had access to their call systems while in bed for three residents. Resident #10 was observed awake in bed with his call light under the bed and out of reach on two separate observations. He stated that residents push the button or holler out for help, but he was unable to reach the call light. Resident #10’s record showed moderate cognitive impairment with a BIMS score of 12/15, partial/moderate assistance needed with toileting, supervision or touching assistance needed with bed mobility and transfers, and frequent urinary incontinence and always bowel incontinence. His care plan specifically directed staff to ensure his call light was within reach and to encourage him to use it for assistance as needed. Resident #20, who had intact cognition with a BIMS score of 15/15, also had his call light observed under his bed and out of reach, and he stated he did not know how long it had been there. Resident #31 was observed in bed asleep with her call light underneath the bed and not within reach on two observations; when interviewed, she could not locate the device from where she was sitting. During interview, the Interim DON stated that the call bell was the device provided for residents to alert staff, that placement was monitored whenever staff entered rooms, and that it was everybody’s responsibility to ensure call lights were within reach.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near South Daytona
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Carlton Shores Healthcare And Rehabilitation Cente | 2.1 mi | ★★★★★ | 4 | 0 |
| Seaside Health And Rehabilitation Center | 2.1 mi | ★★★★★ | 0 | 0 |
| Beach Street Health And Rehabilitation Center | 2.5 mi | ★★★★★ | 0 | 0 |
| Port Orange Nursing And Rehab Center | 2.8 mi | ★★★★★ | 8 | 2 |
| Blue Palms Health And Rehabilitation Center Of Day | 3.4 mi | ★★★★★ | 6 | 0 |
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