F 0770
Provide timely, quality laboratory services/tests to meet the needs of residents.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review and interview, the facility failed to report the laboratory results to the physician in a timely
manner in accordance with professional standards of practice for 1 of 3 residents reviewed for hospital
transfers (Resident 1).Findings include:Review of Resident #1's admission record showed the resident was
most recently admitted on [DATE] with the diagnoses including right dominant side hemiplegia, acute
kidney failure, dementia, cognitive communication deficit, type 2 diabetes mellitus, pulmonary fibrosis,
edema, and failure to thrive.Review of Resident #1's laboratory results showed the first partial result on
7/2/2025 at 1:17 PM and the second partial result on 7/2/2025 at 1:37 PM, and the final result on 7/2/2025
at 1:42 PM. The reports showed abnormal BUN (Blood Urea Nitrogen; a blood test that measures the
amount of urea in the blood, primarily to assess kidney function) result of 90 H (high), with the normal
range being 8-27 mg/dL (milligram/deciliter); abnormal Creatinine (waste product from normal muscle and
protein breakdown, released into the bloodstream and filtered by the kidneys into urine.) result of 3.9 H,
with normal range being 0.5-0.9 mg/dL.Review of Resident #1's daily progress notes for 7/2/2025,
7/3/2025, and 7/4/2025 showed no documentation of laboratory results being reported to physician.Review
of Resident #1's physician progress note dated 7/2/2025 showed it read, History of Present Illness:
General: 74 yo [years old] with medical h/o [history of] DM2 [type 2 diabetes mellitus]/Neuropathy,
Fibromyalgia, HTN [hypertension], HLD [hyperlipidemia], CVA [cerebrovascular accident] with residual
hemiplegia, cognitive communication deficient, was recently hospitalized due to AKI [Acute Kidney Injury],
Weakness, FIT [Failure to Thrive]. Treated and stabilized at hospital. Transferred to this facility to continue
medical treatment and skilled rehabilitation. Patient is being seen today for follow up and review
management. At evaluation, pt [patient] is alert and oriented in person, in no distress. Denies chest pain, no
SOB [Shortness of Breath], no nausea or vomiting, no abdominal pain. No pain at evaluation. Generalized
weakness more left side hemibody. PT/OT/ST [Physical Therapy/ Occupational Therapy/ Speech Therapy]
to evaluate and treat. Assist with ADLs [Activities of Daily Living]. Falls precautions.During a telephone
interview on 9/10/2025 at 3:00 PM, the Physician stated, I do not recall a call for her [Resident #1] results. I
saw the patient that day and only that day. As per my routine when in the facility, I visit new admission first
thing in the morning, then continue to see others in the facility. Lab result from any day will start coming in
around 2 PM. The result should have been reported to me that day.During an interview on 9/10/2025 at
2:13 PM, the Director of Nursing (DON) stated, The labs results should have been reported to the physician
immediately.Review of the facility policy and procedure titled Diagnostic Services revised on 3/2/2019
showed it read, Policy: It is the policy of this facility to ensure that laboratory, radiology, and other diagnostic
services meet the needs of residents, that results are reported promptly to the ordering provider to address
potential concerns and for disease prevention, provide for resident assessment, diagnosis, and treatment,
and that the facility has established policies and
Residents Affected - Few
(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 2
Event ID:
105333
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
105333
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/10/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Avante at MT Dora, Inc
3050 Brown Ave
Mount Dora, FL 32757
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)
F 0770
Level of Harm - Minimal harm
or potential for actual harm
procedures, and is responsible for the quality and timeliness of services whether services are provided by
the facility or an outside resource. Procedure: 4. The facility will promptly notify the ordering physician,
physician assistant, nurse practitioner, or clinical nurse specialist of laboratory results that fall outside of the
clinical reference ranges in accordance with the facility policies and procedures for notification of a
practitioner or per the ordering physician's orders.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105333
If continuation sheet
Page 2 of 2