Health inspection·March 1, 2023

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure respiratory services were provided in accordance with professional standards for 1 of 2 residents reviewed for respiratory care, Resident #45. Residents Affected - Some Findings include: During an observation on 2/26/2023 at 9:33 AM, Resident #45 was in his room seated in a wheelchair, receiving oxygen at 2.5 liters via nasal cannula. During an observation on 2/28/2023 at 8:58 AM, Resident #45 was seated in a wheelchair in his room beside his bed. The oxygen concentrator beside Resident #45's bed was running at 2 liters but was not in use by Resident #45. During an interview on 2/28/2023 at 9:30 AM, after observing Resident #45's room, Staff A, Licensed Practical Nurse (LPN), confirmed that there was an oxygen concentrator in Resident #45's room at his bed side for use by Resident #45. Review of admission Plan of Care note dated 1/20/2023 for Resident #45 reads, The resident has respiratory failure. The resident's lungs are clear. The resident is not receiving oxygen. Review of Daily Skilled Note dated 2/1/2023 for Resident #45 documented that the resident was on oxygen. Review of Resident #45's physician's orders, active orders as of 2/28/2023, showed Resident #45's physician's order for oxygen via nasal cannula had a start date of 2/28/2023. The physician's order for Resident #45 to receive oxygen via nasal cannula was obtained 27 days after the facility documented oxygen therapy had started for Resident #45. During an interview on 2/28/2023 at 9:20 AM, Staff A, LPN, confirmed Resident #45 did not have an active physician's order to be administered oxygen. During an interview on 2/28/2023 at 9:37 AM, the Director of Nursing confirmed Resident #45 did not have an active physician's order or a discontinued physician's order to be administered oxygen. Review of the facility policy and procedure titled General Dose Preparation and Medication Administration last revised on 1/1/2022 and last reviewed on 1/19/2023, reads, Procedure . 4. Prior to administration of medication, Facility staff should take all measures required by Facility policy and Applicable Law, including, but not limited to the following: 4.1 Facility staff should: 4.1.1 Verify Page 1 of 5 105333 105333 03/01/2023 Avante at MT Dora, Inc 3050 Brown Ave Mount Dora, FL 32757

F 0695 Level of Harm - Minimal harm or potential for actual harm each time a medication is administered that it is the correct medication, at the correct dose, at the correct route, at the correct rate, at the correct time, for the correct resident, as set forth in facility's medication administration schedule. 4.1.2 Confirm that the MAR Medication Administration Record] reflects the most recent medication order. Residents Affected - Some 105333 Page 2 of 5 105333 03/01/2023 Avante at MT Dora, Inc 3050 Brown Ave Mount Dora, FL 32757

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review, the facility failed to ensure nurse staffing information was posted on a daily basis. Residents Affected - Many Findings include: During an observation on 2/26/2023 at 8:55 AM, the nurse staffing information posted on the wall behind the desk in the front lobby was dated 2/24/2023. During an interview on 2/26/2023 at 10:55 AM, the Director of Nursing stated, It is her expectation to have the staffing information posted and readily available with the correct information at the beginning of each shift, by the front desk receptionist. Review of the facility policy and procedures titled Nursing Services- Nurse Staffing Information revised on 3/2/2019 reads, Policy: It is the policy of the facility to make staffing information readily available in a readable format to residents and visitors at any given time. Procedure: 1. The facility will post the following information on a daily basis: a. Facility name b. The current date . 2. The facility will post the nurse staffing data on a daily basis at the beginning of each shift. 105333 Page 3 of 5 105333 03/01/2023 Avante at MT Dora, Inc 3050 Brown Ave Mount Dora, FL 32757

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the drugs and biologicals used in the facility were labeled and stored in accordance with currently accepted professional principles in 4 of 4 medication carts and Wing 1 Medication Room. Findings include: On [DATE] at 9:10 AM, during an observation of Unit 1 Medication Cart 1 with Staff B, Licensed Practical Nurse (LPN), there was an opened Insulin Glargine Pen with no opened date documented. During an interview on [DATE] at 9:10 AM, Staff B, LPN, stated, Yes it should be dated once opened. On [DATE] at 9:19 AM, during an observation of Unit 1 Medication Cart 2 with Staff C, LPN, there was an unopened Insulin Glargine Pen in the cart with a label to refrigerate until opened. During an interview on [DATE] at 9:19 AM, Staff C, LPN, stated, I don't know how long it has been there. I don't use that insulin. That is a night time medication. On [DATE] at 9:30 AM, during an observation of the refrigerator of Unit 1 Medication Room with Staff D, LPN, there were one syringe of Aplisol 0.1 milliliter (ml) labeled as expired on [DATE] and one bottle of Omeprazole 2 milligram (mg)/ml labeled as expired on [DATE]. During an interview on [DATE] at 9:30 AM, Staff D, LPN, stated, These medications should have been removed from the refrigerator. On [DATE] at 9:45 AM, during an observation of Unit 2 Rehab Cart 2 with Staff E, LPN, there was one Saline Nasal Spray dated [DATE] with no resident identifier and one Thiamin vial with no security tab. During an interview on [DATE] at 9:45 AM, Staff E, LPN, stated, The nasal spray should have a resident name on the bottle and the Thiamine should have the cap. On [DATE] at 9:58 AM, during an observation of Unit 2 Rehab Cart 1 with Staff F, Registered Nurse (RN), there was one Insulin Aspart 70/30 Pen with three different dates of [DATE], [DATE] and [DATE]. During an interview on [DATE] at 9:58 AM, Staff F, RN, stated she could not be sure on which day the insulin pen was opened. During an interview on [DATE] at 11:25 AM, the Director of Nursing (DON) stated her expectation was for the nurses to keep the medications labeled properly and insulin to be refrigerated until opened. Review of the facility policy and procedure titled Pharmacy Services revised on [DATE] reads, Policy: It is the policy of the facility to provide care and services related to Pharmacy Services in accordance to State and Federal regulation. Procedures . 10. Drugs and biologicals used in the facility 105333 Page 4 of 5 105333 03/01/2023 Avante at MT Dora, Inc 3050 Brown Ave Mount Dora, FL 32757

F 0761 will be labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 105333 Page 5 of 5