Health inspection·January 10, 2024

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on interviews, medical record review, and facility policy and procedure review, the facility failed to ensure residents were free from any significant medication errors, by failing to administer medications within the specified timeframe based on physician's scheduling orders for ten (Residents #1, #3, #4, #5, #9, #10, #11, #12, #13, and #14) of fourteen sampled residents, from a total census of 101. Failure to administer medications in a timely manner can result in a resident's inability to maintain the proper level of medication in the bloodstream to be effective; reduced functional ability; lower quality of life; hospitalization, disease progression, and/or death. Residents Affected - Some The findings include: On 1/9/24 at 9:30 AM, the administrator was requested to provide a copy of current Quality Assurance and Performance Improve (QAPI)/Performance Improvement Project (PIP) being conducted at the facility. On 1/9/24 at 11:01 AM, the administrator was again requested to provide just a list of the current PIPs. On 1/9/24 at 11:20 AM, the administrator provided a list of the QAPI/PIPs that were either initiated or in the process since October 2023. The list did not contain any PIPs to address medication administration. (Copy obtained) On 1/9/24 at 12:25 PM, an interview was conducted with Director of Nursing (DON). The DON stated that an ad hoc PIP had been initiated in December for medication administration. When she was asked why it was not on the list, she said, because it was an ad hoc PIP and had not gone to QAPI in December. 1. A review of Resident #1's medical record revealed an admission date of 10/8/23 and discharge date of 11/26/23 with diagnoses that included hemiplegia/hemiparesis following CVA affecting left non-dominant side, facial weakness, muscle weakness, difficulty walking with lack of coordination, dysphagia and gastrostomy. On 1/10/24 at 9:00 AM, the Director of Nursing (DON) was requested to provide Resident #1's Medication Administration Audit (MAA) report for the period 11/1/23 through 11/30/23. The 79-page report was received at 9:25 AM. (Copy obtained) A review of Resident #1's MAA Report from 11/1/23 through 11/26/23, revealed that his medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) on 21 of 30 days as follows: Page 1 of 9 105310 105310 01/10/2024 Avante at Ormond Beach, Inc 170 N Kings Road Ormond Beach, FL 32174

F 0760 On 11/1/23, the medication Gabapentin (pain) was scheduled for 8 AM, it was administered at 9:34 AM. Level of Harm - Minimal harm or potential for actual harm On 11/4/23, Gabapentin was scheduled for 8 AM, it was administered at 10:31 AM. The following medications were scheduled for 9 AM, they were administered between 10:32 and 10:36 AM: Escitalopram Oxalate (depression), Carbidopa-Levodopa (Parkinsons), Cholecalciferol (deficiency), Ascorbic Acid Tablet (deficiency), Lorazepam (anxiety), Lisinopril (hypertension), Rivaroxaban (Cerebrovascular Accident -CVA), and Famotidine (Gastroesophageal reflux disease-GERD). Residents Affected - Some On 11/5/23, Gabapentin was scheduled for 8 AM, it was administered at 11:34 AM. The following medications were scheduled for 9 AM, they were administered between 11:34 and 11:37 AM: Escitalopram Oxalate, Carbidopa-Levodopa, Cholecalciferol, Ascorbic Acid Tablet, Lorazepam, Lisinopril, Rivaroxaban, and Famotidine. On 11/6/23, Gabapentin was scheduled for 8 AM, it was administered at 9:59 AM. On 11/8/23, Gabapentin was scheduled for 8 AM, it was administered at 9:14 AM. On 11/9/23, Gabapentin was scheduled for 8 AM, it was administered at 9:32 AM and was scheduled for 20:00 PM, it was administered at 22:34 PM. Famotidine was scheduled for 21:00 PM, it was administered at 22:36 PM. On 11/10/23, Gabapentin was scheduled for 8 AM, it was administered at 14:04 PM; it was scheduled again for 20:00 PM and was administered at 21:40 PM. The following medications were scheduled for 9 AM, they were administered at 14:04 PM: Escitalopram Oxalate, Carbidopa-Levodopa, Cholecalciferol, Ascorbic Acid, Lorazepam, Lisinopril, Rivaroxaban, and Famotidine. Carbidopa-Levodopa was scheduled for 18:00 PM, it was administered at 21:40 PM. On 11/11/23, Gabapentin was scheduled for 8 AM, it was administered at 9:38 AM. On 11/12/23, Gabapentin was scheduled for 8 AM, it was administered at 9:33 AM. On 11/13/23, Gabapentin was scheduled for 8 AM, it was administered at 16:32 PM. The following medications were scheduled for 9 AM, they were administered between 16:32 and 16:41 PM: Escitalopram Oxalate, Carbidopa-Levodopa, Cholecalciferol, Ascorbic Acid, Lorazepam, Lisinopril Rivaroxaban, and Famotidine. On 11/14/23, Gabapentin was scheduled for 8 AM, it was administered at 9:34 AM. Carbidopa-Levodopa was scheduled for 17:00 PM, it was administered at 18:51 PM. On 11/16/23, Gabapentin was scheduled for 8 AM, it was administered at 9:37 AM. Carbidopa-Levodopa was scheduled for 17:00 PM, it was administered at 18:54 PM. On 11/17/23, Gabapentin was scheduled for 8 AM, it was administered at 9:01 AM; it was scheduled again at 20:00 PM and was administered at 22:24 PM. The following medications were scheduled for 21:00 PM, they were administered at 22:24 PM: Mirtazapine, Lorazepam, and Famotidine. On 11/18/23, Gabapentin was scheduled for 8 AM, it was administered at 13:25 PM. The following medications were scheduled for 9 AM, they were administered between 13:25 and 13:45 PM: Escitalopram 105310 Page 2 of 9 105310 01/10/2024 Avante at Ormond Beach, Inc 170 N Kings Road Ormond Beach, FL 32174

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Oxalate, Carbidopa-Levodopa, Cholecalciferol, Ascorbic Acid, Lorazepam, Lisinopril, Rivaroxaban, and Famotidine. Carbidopa-Levodopa was scheduled for 17:00 PM, it was administered at 18:44 PM On 11/19/23, Gabapentin was scheduled for 8 AM, it was administered at 12:32 PM. The following medications were scheduled for 9 AM, they were administered at 12:32 PM: Escitalopram Oxalate, Carbidopa-Levodopa, Cholecalciferol, Ascorbic Acid, Lorazepam, Lisinopril, Rivaroxaban, and Famotidine. Carbidopa-Levodopa was scheduled for 17:00 PM, it was administered at 18:50 PM On 11/20/23, Gabapentin was scheduled for 8 AM, it was administered at 9:25 AM. On 11/21/23, Gabapentin was scheduled for 8 AM, it was administered at 10:58 AM. The following medications were scheduled for 9 AM, they were administered between 10:58 and 11:09 AM: Escitalopram Oxalate, Carbidopa-Levodopa, Cholecalciferol, Ascorbic Acid, Lorazepam, Lisinopril, Rivaroxaban, and Famotidine. Carbidopa-Levodopa was scheduled for 17:00 PM, it was administered at 18:09 PM On 11/22/23, Gabapentin was scheduled for 8 AM, it was administered at 10:16 AM. The following medications were scheduled for 9 AM, they were administered between 10:19 and 10:27 AM: Escitalopram Oxalate, Carbidopa-Levodopa, Cholecalciferol, Ascorbic Acid, Lorazepam, Lisinopril, Rivaroxaban, and Famotidine. On 11/23/23, Gabapentin was scheduled for 8 AM, it was administered at 9:28 AM; it was scheduled again at 20:00 PM and was administered at 21:11 PM. On 11/24/23, Gabapentin was scheduled for 8 AM, it was administered at 9:12 AM. Carbidopa-Levodopa was scheduled for 17:00 PM, it was administered at 19:18 PM On 11/26/23, Gabapentin was scheduled for 8 AM, it was administered at 9:04 AM. (Copy obtained) 2. A review of Resident #3's medical record revealed an admission date of 11/2/23 and discharge date of 11/17//23 with diagnoses that included hepatic encephalopathy, depression, anxiety, persistent mood disorder. On 1/10/24, the DON was requested to provide Resident #3's MAA Report for the period 11/1/23 through 11/30/23. The 48-page report was received at 9:31 AM. (Copy obtained) A review of Resident #3's MAA Report from 11/2/23 through 11/17/23, revealed that her medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) on 14 of 16 days as follows: On 11/2/23, the following medications were scheduled for 21:00 PM, they were administered between 22:25 PM and 22:26 PM: Propranolol HCI (htn), Magnesium Oxide (deficiency), Pantoprazole Sodium (Gerd) and Rifaximin (liver cirrhosis). On 11/3/23, Lactulose (hepatic encephalopathy) was scheduled for 12:00 PM, it was administered at 13:43 PM. On 11/4/23, the following medications were scheduled for 9 AM, they were administered between 10:41 and 10:43 AM: Furosemide (chronic obstructive pulmonary disease-COPD), Clonazepam (anxiety), Rifaximin, Propranolol HCI, and Pantoprazole Sodium. 105310 Page 3 of 9 105310 01/10/2024 Avante at Ormond Beach, Inc 170 N Kings Road Ormond Beach, FL 32174

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 11/5/23, Lactulose was scheduled for 8:00 AM, it was administered at 11:30 AM. The following medications were scheduled for 9 AM, they were administered at 11:32 AM: Furosemide, Rifaximin, Propranolol HCI, and Pantoprazole Sodium. On 11/6/23, Lactulose was scheduled for 8:00 AM, it was administered at 9:51 AM. The medication was scheduled again for 12:00 PM, it was administered at 14:59 PM. On 11/8/23, Lactulose was scheduled for 12:00 PM, it was administered at 13:42 PM. On 11/9/23, Lactulose was scheduled for 8:00 AM, it was administered at 9:21 AM. Prednisone (Thrombocytopenia) was scheduled for 8:00 AM, it was administered on 9:19 AM. Rifaximin was scheduled for 21:00 PM, it was administered at 22:31 PM. On 11/10/23, Lactulose was scheduled for 8:00 AM, it was administered at 9:49 AM. The medication was scheduled again for 12:00 PM, it was administered at 14:03 PM. Prednisone was scheduled for 8:00 AM, it was administered on 9:48 AM. The following medications were scheduled for 21:00 PM, they were administered at 22:34 PM: Propranolol HCI, Magnesium Oxide, and Pantoprazole Sodium. On 11/11/23, Lactulose was scheduled for 8:00 AM, it was administered at 9:13 AM. Prednisone was scheduled for 8:00 AM, it was administered on 9:10 AM. On 11/12/23, Lactulose was scheduled for 12:00 PM, it was administered at 13:17 PM. On 11/13/23, Prednisone was scheduled for 8:00 AM, it was administered on 10:30 AM. Rifaximin was scheduled for 9:00 AM, it was administered on 16:26 PM. Lactulose was scheduled for 12:00 PM, it was administered at 16:27 PM. On 11/14/23, Rifaximin was scheduled for 9:00 AM, it was administered on 13:14 PM. Lactulose was scheduled for 12:00 PM, it was administered at 13:14 PM On 11/15/23, Lactulose was scheduled for 8:00 AM, it was administered at 9:02 AM. Prednisone was scheduled for 8:00 AM, it was administered on 9:05 AM. On 11/17/23, Furosemide was scheduled for 9:00 AM, it was administered at 14:08 PM. Lactulose was scheduled for 17:00 PM, it was administered at 23:59 PM. (Copy obtained) 3. A review of Resident #4's medical record revealed an admission date of 5/17/23 with diagnoses that included intracerebral Hemorrhage, cirrhosis of liver, weakness, difficulty walking, muscle wasting, cognitive communication deficit, Anemia, alcohol dependence, falls, ascites, nicotine dependence, unspecified dementia, hypotension, hypokalemia On 1/10/24, the DON was requested to provide Resident #4's MAA Report for the period 12/1/23 through 12/31/23. The 65-page report was received at 9:26 AM. (Copy obtained) A review of Resident #4's MAA Report from 12/1/23 through 12/31/23, revealed that his medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) on 9 of 31 days as follows: On 12/2/23, the following medications were scheduled for 21:00 PM, they were administered between 105310 Page 4 of 9 105310 01/10/2024 Avante at Ormond Beach, Inc 170 N Kings Road Ormond Beach, FL 32174

F 0760 22:29 PM and 22:30 PM: Levetiracetam (seizures) and Memantine HCI (dementia). Level of Harm - Minimal harm or potential for actual harm On 12/8/23, Melatonin was scheduled for 22:00 PM, it was administered at 23:06 PM Residents Affected - Some On 12/11/23, the following medications were scheduled for 9:00 AM, they were administered between 13:31 PM and 13:32 PM: Furosemide, Metoprolol Succinate (htn), Levetiracetam (seizures), Thiamine HCI (supplement), Spironolactone (diuretic), Folic Acid (supplement), Memantine HCI (dementia), and Ferrous Sulfate (supplementation). On 12/14/23, the following medications were scheduled for 9:00 AM, they were administered between 13:54 PM and 13:59 PM: Furosemide, Levetiracetam, Metoprolol Succinate, Thiamine HCI, Spironolactone, Folic Acid, Memantine HCI, Ferrous Sulfate, and Andro Gel Transdermal (testosterone). On 12/16/23, the following medications were scheduled for 21:00 PM, they were administered at 22:05 PM: Levetiracetam and Memantine HCI. On 12/18/23, the following medications were scheduled for 21:00 PM, they were administered at 22:49 PM: Levetiracetam and Memantine HCI. On 12/21/23, Memantine HCI was scheduled for 9:00 AM, it was administered at 10:29 AM. On 12/26/23, the following medications were scheduled for 9:00 AM, they were administered between 11:43 AM and 11:49 AM: Furosemide, Levetiracetam, Metoprolol Succinate, Thiamine HCI, Spironolactone, Folic Acid, Memantine HCI, Ferrous Sulfate, and AndroGel Transdermal. On 12/29/23, the following medications were scheduled for 9:00 AM, they were administered between 10:36 AM and 13:12 PM: Furosemide, Levetiracetam, Metoprolol Succinate, Thiamine HCI, Spironolactone, Folic Acid, Memantine HCI, Ferrous Sulfate), and Andro Gel Transdermal. (Copy obtained) 4. On 1/10/24, the DON was requested to provide Resident #5's MAA Report for the period 12/14/23. The 12-page report was received at 9:31 AM. (Copy obtained) A review of Resident #5's MAA Report on 12/14/23, revealed that her medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) as follows: On 12/14/23, Metformin HCI (diabetes) was scheduled for 8:00 AM, it was administered at 10:25 AM. The following medications were scheduled for 9:00 AM, they were administered between 10:29 AM and 10:40 AM: Scopolamine Base Patch (tracheal secretions), Potassium Chloride Liquid (hypokalemia), Carvedilol (htn), Sacubitril-Valsartan (htn), and Insulin Glargine Subcutaneous Solution (type 2 diabetes mellitus). Humalog Injection Solution (diabetes) was scheduled for 11:30 AM, it was administered at 12:54 PM. (Copy obtained) 5. On 1/10/24, the DON was requested to provide Resident #9's MAA Report for the period 1/1/24 through 1/7/24. The 28-page report was received at 11:51 AM. (Copy obtained) A review of Resident #9's MAA Report from 1/1/24 thru 1/7/24, revealed that her medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) on 3 of 7 days as follows: 105310 Page 5 of 9 105310 01/10/2024 Avante at Ormond Beach, Inc 170 N Kings Road Ormond Beach, FL 32174

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 1/1/24, Gabapentin was scheduled for 17:00 PM, it was administered at 22:08 PM. Melatonin was scheduled for 20:00 PM, it was administered 22:08 PM. Clonazepam, Sennosides-Docusate Sodium (constipation), and Hydralazine HCI (hypertension) were scheduled for 21:00 PM, they were administered at 22:08 PM. On 1/2/24, Melatonin was scheduled for 20:00 PM, it was administered at 23:22 PM. Clonazepam, Sennosides-Docusate Sodium, and Hydralazine HCI were scheduled for 21:00 PM, they were administered at 23:22 PM. On 1/5/24, Cyanocobalamin (VitB 12) was scheduled for 10 AM, it was administered at 11:24 AM. (Copy obtained) 6. On 1/10/24, the DON was requested to provide Resident #10's MAA Report for the period 1/1/24 through 1/7/24. The 40-page report was received at 11:49 AM. (Copy obtained) A review of Resident #10's MAA Report from 1/1/24 thru 1/7/24, revealed that his medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) on 6 of 7 days as follows: On 1/1/24, Gabapentin was scheduled for 16:00 PM, it was administered at 17:17 PM. Apixaban was scheduled for 21:00 PM, it was administered at 22:35 PM. On 1/2/24, Gabapentin was scheduled for 16:00 PM, it was administered at 17:17 PM. On 1/3/24, Gabapentin was scheduled for 8:00 AM, it was administered at 9:36 AM. Invega Sustenna Intramuscular Suspension (Schizoaffective disorder) was scheduled for 9:00 AM, it was administered at 11:44 AM. The following medications were scheduled for 17:00 PM, they were administered at 22:18 PM: Lamotrigine (mood), Calorically Dense Oral Supplement, and Mirtazapine. On 1/4/24, Gabapentin was scheduled for 16:00 PM, it was administered at 17:28 PM On 1/5/24, Gabapentin was scheduled for 8:00 AM, it was administered at 11:40 AM and scheduled again for 16:00 PM, it was administered at 17:36 PM. The following medications were scheduled for 9:00 AM, they were administered between 11:39 AM and 11:40 AM: Magnesium Oxide (deficiency), Apixaban, Topiramate (brain injury), Ferrous Sulfate, Mirtazapine, Bupropion HCI ER (depression). On 1/7/24, Gabapentin was scheduled for 8:00 AM, it was administered at 9:13 AM, and was scheduled again at 12:00 PM, it was administered at 13:07 PM. (Copy obtained) 7. On 1/10/24, the DON was requested to provide Resident #11's MAA Report for the period 1/1/24 through 1/7/24. The 29-page report was received at 11:50 AM. (Copy obtained) A review of Resident #11's MAA Report from 1/1/24 thru 1/7/24, revealed that his medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) on 5 of 7 days as follows: On 1/2/24, the following medications were scheduled for 8:00 AM, they were administered at 9:04 AM: Phenytoin Sodium Extended (seizure disorder), Famotidine (indigestion), and Memantine HCI (anxiety). 105310 Page 6 of 9 105310 01/10/2024 Avante at Ormond Beach, Inc 170 N Kings Road Ormond Beach, FL 32174

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 1/3/24, the following medications were scheduled for 20:00 PM, they were administered at 22:22 PM: Phenytoin Sodium Extended, Ropinirole Hydrochloride (multiple sclerosis), Famotidine, and Levetiracetam (epilepsy). On 1/4/24, the following medications were scheduled for 8:00 AM, they were administered between 9:17 AM and 9:19 AM: Phenytoin Sodium Extended, Levetiracetam Famotidine, and Memantine HCI. On 1/5/24, the following medications were scheduled for 8:00 AM, they were administered at 11:04 AM: Phenytoin Sodium Extended, Levetiracetam, Famotidine, and Memantine HCI. Escitalopram Oxalate scheduled for 9:00 AM, it was administered at 11:04 AM. On 1/7/24, the following medications were scheduled for 8:00 AM, they were administered at 10:23 AM: Phenytoin Sodium Extended, Levetiracetam, Famotidine, and Memantine HCI. Escitalopram Oxalate scheduled for 9:00 AM, it was administered at 10:23 AM. (Copy obtained) 8. On 1/10/24, the DON was requested to provide Resident #12's MAA Report for the period 1/1/24 through 1/7/24. The 33-page report was received at 11:56 AM. (Copy obtained) A review of Resident #12's MAA Report from 1/1/24 thru 1/7/24, revealed that her medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) on 5 of 7 days as follows: On 1/1/24, Fluoxetine HCI (depression) was scheduled for 9:00 AM, it was administered at 10:52 AM. The following medications were scheduled for 21:00 PM, they were administered at 22:04 PM: Arginine (supplement), Apixaban (blood thinner), Sennosides-Docusate Sodium (constipation), Ferrous Sulfate (supplementation), and Trazodone HCI (depression). On 1/2/24, Acetaminiphen-Codeine (pain) was scheduled for 0:00 AM, it was administered at 3:25 AM On 1/5/24, the following medications were scheduled for 9:00 AM, they were administered at 15:02 PM: Ferrous Sulfate, Apixaban, Fluoxetine HCI, ProHeal (nutritional supplement), and Acetaminiphen-Codeine. ProHeal was scheduled again at 13:00 PM, it was administered at 15:02 PM. On 1/6/24, ProHeal was scheduled for 17:00 PM, it was administered at 18:22 PM. Ascorbic Acid was scheduled at 20:00 PM, it was administered at 21:29 PM. On 1/7/24, Acetaminiphen-Codeine was scheduled at 0:00 AM, it was administered at 2:04 AM. (Copy obtained) 9. On 1/10/24, the DON was requested to provide Resident #13's MAA Report for the period 1/1/24 through 1/7/24. The 31-page report was received at 11:57 AM. (Copy obtained) A review of Resident #13's MAA Report from 1/1/24 thru 1/7/24, revealed that his medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) on 5 of 7 days as follows: On 1/1/24, Percocet (pain) was scheduled for 8:00 AM, it was administered at 9:03 AM. On 1/2/24, Percocet was scheduled for 0:00 AM, it was administered at 1:07 AM 105310 Page 7 of 9 105310 01/10/2024 Avante at Ormond Beach, Inc 170 N Kings Road Ormond Beach, FL 32174

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 1/3/24, Percocet was scheduled for 8:00 AM, it was administered at 9:33 AM. Hydralazine HCI was scheduled for 8 AM, it was administered at 9:26 AM. Rosuvastatin Calcium (hyperlipidemia) was scheduled at 17:00 PM, it was administered at 19:05 PM. On 1/4/24, Percocet was scheduled for 8:00 AM, it was administered at 9:05 AM. Percocet was scheduled for 12:00 PM, it was administered at 13:26 PM. Percocet was scheduled for 16:00 PM, it was administered at 17:36 PM. Hydralazine HCI was scheduled for 8 AM, it was administered at 9:06 AM. Hydralazine HCI was scheduled for 12 PM, it was administered at 13:25 PM. Hydralazine HCI was scheduled for 16:00 PM, it was administered at 17:35 PM. On 1/5/24, Percocet was scheduled for 20:00 PM, it was administered at 21:19 PM. (Copy obtained) 10. On 1/10/24, the DON was requested to provide Resident #14's MAA Report for the period 1/1/24 through 1/7/24. The 41-page report was received at 11:57 AM. (Copy obtained) A review of Resident #14's MAA Report from 1/1/24 thru 1/7/24, revealed that his medications were administered outside of the acceptable two-hour administration window (one hour before to one hour after) on 5 of 7 days as follows: On 1/2/24, Sucralfate was scheduled for 16:30 PM, it was administered at 17:53 PM. On 1/3/24, Linaclotide (constipation) and Amlodipine Besylate (htn) were scheduled for 8:00 AM, they were administered at 12:15 PM. The following medications were scheduled for 9:00 AM, they were administered between 12:15 PM and 12:21 PM: Calorically Dense Supplement, Sennosides-Docusate Sodium, and Apixaban. Sucralfate was scheduled for 16:30 PM, it was administered at 17:37 PM. On 1/4/24, Linaclotide and Amlodipine Besylate were scheduled for 8:00 AM, they were administered at 9:11 AM. Sucralfate was scheduled for 11:30 AM, it was administered at 15:24 PM. Calorically Dense Supplement was scheduled for 13:00 PM, it was administered at 15:23 PM. On 1/6/24, Linaclotide and Amlodipine Besylate were scheduled for 8:00 AM, they were administered at 9:17 AM. Mirtazapine and Melatonin were scheduled for 22:00 PM, they were administered at 1:26 AM. Apixaban was scheduled for 21:00 PM, it was administered at 23:39 PM. On 1/7/24, Linaclotide was scheduled for 8:00 AM, it was administered at 9:18 AM. (Copy obtained) On 1/10/24 at 9:30 AM, the Medication Administration Audits for Residents #1, #3, #4, #5, #9, #10, #11, #12, #13, and #14 were reviewed with the DON. The audits revealed repeated medication administration errors (timeliness of administration) for Residents #1, #3, #4, #5, #9, #10, #11, #12, #13, and #14. On 1/10/24 at 12:40 PM, an interview was conducted with Licensed Practical Nurse D, regarding medication administration. She stated that nurses are to document medication administration at the time of administration. She explained that the facility protocol states medication administration can be given one hour before to one hour after the scheduled time and if administration is late to call the physician and document in Electronic Medical Records (EMR). On 1/10/24 at 12:50 PM, an interview was conducted with LPN I, regarding medication administration. She explained that nurses can give medication one hour before or one hour after the scheduled time 105310 Page 8 of 9 105310 01/10/2024 Avante at Ormond Beach, Inc 170 N Kings Road Ormond Beach, FL 32174

F 0760 Level of Harm - Minimal harm or potential for actual harm and if given late they call the physician and family and document it in EMR. She stated that medication administration documentation is to be done at time of administration. A review of the facility's policy titled, 6.0 General Dose Preparation and Medication Administration (1/2022) revealed the following: Residents Affected - Some Page 2, item 5.4 Administer medications within time frames specified by Facility policy or manufacturer's information. (Photographic evidence obtained) . 105310 Page 9 of 9