Inspection·November 4, 2024

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and interview, the facility failed to provide evidence that the staff provided care and services that met professional standards of quality as evidenced by the staff failure to follow the physician orders for medication administration for 8 of 12 residents reviewed (Residents #7, #8, #9, #11, #12, #13, #14, #15). Residents Affected - Some The findings included: 1) Review of the clinical record for Resident #8 revealed that the resident is one of 30 evacuated residents who remained in the facility after the storm. They arrived to this facility on 10/07/24. According to the Director of Nursing (DON) in an interview on 10/31/24 at 3:45 PM, she stated that when the other facility's staff left on 10/18/24, they took the Medication and Treatment Administration Records (MAR and TAR) with them but she gained access to their system and printed the MAR and TAR for the remaining residents to ensure her staff could provide the necessary care and services as of October 18, 2024. Review of the Medication Administration Record for October 2024 revealed that the staff failed to place their initials in the appropriate boxes to indicate the medications were administered as prescribed as follows: Resident #8 was prescribed 11 oral medications and 2 intravenous medications. The MAR documented multiple doses that were not signed as administered by the nurses. Additionally, an observation of medications being returned to the previous facility's pharmacy was conducted on 11/04/24 at approximately 3:50 PM revealed that the staff had the medications available. a. Finasteride Oral Tablet 5 mg Give 1 tablet by mouth for BPH revealed 3 doses were not signed for, with 2 of the 3 doses the nurse noted the medication was not available. b. Venlafaxine HCL Oral tablet 37.5 mg one tablet once for depression, 3 missed doses. c. Rulukek Oral tablet give 1 tablet by mouth twice daily for ALS, 7 missed doses. d.Trazadone HCL 50 mg give 0.5 tablet by mouth two times for depression, 9 missed doses. e. Midodrine HCL 10 mg tablet give one tablet every 8 hours for hypotension, 14 missed doses. f. Quetiapine Fumarate Oral tablet 25 mg give 0.5 mg tablet three times for brief psychosis, 13 missed doses. (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 10 Event ID: 105257 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 105257 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Saint Lucie 611 S 13th St Fort Pierce, FL 34950 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)