Health inspection·December 21, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview, and policy review, the facility failed to maintain restroom faucets and over bed tables in good condition in 5 of 16 sampled rooms. (Rooms 200, 203, 211, 403, and 405) The findings include: A tour of the 200 and 400 halls was conducted in the presence of the Administrator on 12/20/23 at 3:35 PM. On 12/20/23 at 3:35 PM, it was observed that the sink faucets in rooms 200, 203, 211, 403, and 405 were heavily tarnished. At this time, the Administrator acknowledged that the faucets were tarnished and housekeeping had attempted to clean them, but admitted it may have made the tarnish worse. The Administrator also observed the over bed table in room [ROOM NUMBER] B and confirmed the frame was rusted. (Photographic evidence obtained.) A review of the facility policy Maintenance Plan (effective 11/30/2014) revealed the following: The Company will hire staff or contract for services to ensure the continued maintenance of the Residence. The building and grounds will be maintained in a clean, orderly condition and in good repair either by staff or a contracted landscaper. All equipment and furnishings will be maintained in good condition. Page 1 of 2 105148 105148 12/21/2023 Aviata at Emerald Shores 626 N Tyndall Pkwy Callaway, FL 32404

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 observations, interviews and facility policy review, the facility failed to ensure staff do not administer expired intravenous antibiotics to 1 of 2 sampled residents reviewed for IV antibiotics. (Resident #19) Residents Affected - Few The findings include: On [DATE] at approximately 1:09 PM, an observation was made of Resident #19. During the observation, an intravenous antibiotic bag was observed to be hanging on the intravenous pole. The antibiotic bag displayed three stickers indicating the resident's name, the name of the antibiotic (Ertapenem), and the prescribed dosage (1 gm/100 ml). There was a small, orange square shaped sticker located in the right top corner of the bag indicating an expiration date of [DATE]. On [DATE], a review of Resident #19's Medication Administration Record indicated the intravenous antibiotic was administered on [DATE] at 9:00 AM and signed off as administered by the Infection Preventionist (IP). On [DATE] at approximately 4:01 PM, a phone interview was conducted with the facility's Pharmacist. The Pharmacist was given the prescription number of the expired intravenous antibiotic for validation. The pharmacist indicated the antibiotic was delivered to the facility on [DATE] from the pharmacy. The pharmacist confirmed that the orange sticker indicates the expiration date for the antibiotic and the intravenous fluid the antibiotic was mixed within. On [DATE] at approximately 10:35 AM, an interview was conducted with the Infection Preventionist (IP). The IP confirmed she administered the expired dose of antibiotic. The IP indicated she recalled administering the antibiotic as she was working the floor the morning of [DATE]. The IP indicated she did not notice the expiration date on the intravenous antibiotic bag. On [DATE], a review of the facility's policy entitled Administering Medications (revised [DATE]) indicated, .the expiration/beyond use date on the medication label must be checked prior to administering the medication. On [DATE] at approximately 10:20 AM, an interview was conducted with the Director of Nursing (DON) regarding the expired intravenous antibiotic. The DON indicated the IP should have noticed the expiration sticker located on the intravenous antibiotic bag. 105148 Page 2 of 2