Health inspection·October 10, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm nurse is to notify the attending physician and resident representative when there is a (n): significant change in the patient/resident physical, mental, or psychosocial status, need to alter treatment significantly, new treatment. The nurse is to complete an evaluation of the patient/resident. Document the evaluation in the medical record. Notify the patient/resident and the resident representative of the change in condition. Document the notification in the medical record. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 2 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure all residents were free from medical neglect by failing to ensure staff implemented the policies and procedures for medication administration for 1 of 3 residents reviewed for intravenous (IV) antibiotic medication administration (Resident #1). The facility failure to ensure residents were free from medical neglect by failing to ensure residents were free from significant medication errors when the residents were not administered the prescribed antibiotics per the physician order and failure to ensure the nursing staff had appropriate IV (intravenously) certification to administer IV medications and follow the policy/procedure related to medication administration, physician notification, obtaining stat [derived from the Latin word statim, meaning immediately] orders for medication and equipment, resulted in Immediate Jeopardy. Resident #1 was admitted on [DATE] with physician orders for Vancomycin 1500 mg IV every 8 hours intravenously for infection (osteomyelitis, an infection in the bone). On 9/8/2025 at approximately 10:00 PM, Resident #1 was administered one incorrect dose of Vancomycin 1000 mg. Resident #1 was not administered any further doses of Vancomycin 1500 mg until 9/12/2025 at 12:00 AM. Resident #1 missed 8 doses of Vancomycin between 9/9/2025 and 9/12/2025. On 9/11/2025, Resident #1 began to experience a change in condition of altered mental status, identified by a family member, who requested on 9/12/2025, that Resident #1 be sent to Emergency Department where he was diagnosed with sepsis [a life threatening emergency that damages the body's organs and can cause death]. Missing antibiotic doses can reduce the effectiveness of the treatment and increase the risk of antibiotic resistance, serious harm and/or death, and lack of staff competency related to nursing staff having appropriate IV certification, can result in serious harm including damage to veins and the injection site, an air embolism, phlebitis, and blood clots, injury and/or death.The Administrator was notified of the Immediate Jeopardy on October 10, 2025, at 11:45 AM.Findings include:Review of the policy and procedure titled Abuse, Neglect, Exploitation & Misappropriation last reviewed 02/07/2025 read, Policy: It is inherent in the nature and dignity of each resident at the center that he/she be afforded basic human rights, including the right to be free from abuse, neglect, mistreatment, exploitation and/or misappropriation of property. The management of the facility recognizes these rights and hereby establishes the following statements, policies and procedures to protect these rights to establish a disciplinary policy which results in a fair and timely treatment of occurrences of resident abuse. Employees at the center are charged with a continuing obligation to treat residents so they are free from abuse, neglect, mistreatment, and/or misappropriation of property. No employee may at any time commit an act of physical, psychological, or emotional abuse, neglect, mistreatment, and or misappropriation of property against any resident. Violation of this standard will subject employees to disciplinary action including dismissal provided herein. Definitions: Neglect is the failure of the center, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress.Review of Resident's #1's Discharge summary dated [DATE] from [Name of local hospital] read, Outpatient IV ABX (antibiotic) orders: 1. Cefepime 1 g [gram] q8h [every eight hours] or 3 g q24h [every twenty-four hours] 2. Vancomycin 1500 mg [milligrams] q8h [every eight hours] for 2 weeks.Review of Resident #1's nursing progress note dated 9/8/2025 at 8:31 PM read, Patient was coming around 4:15 PM. With colostomy on his left side and a urostomy on his left side. PICC [Peripherally Inserted Central Catheter] line on his right arm. Vital signs was {sic} within normal range. Patient got left hip surgery paraplegic (related to paraplegia, which is an impairment in motor or sensory function of the lower extremities) and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 3 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few had a drain in the space of the surgery. Patient is alert and oriented times 4.Review of Resident #1's admission record documented an admission date of 9/8/2025 with diagnoses to include subacute osteomyelitis [an infection in the bone], other site, spina bifida occulta [a small gap in one or more of the bones in the spine], other hydrocephalus [a buildup of fluid in the brain], paraplegia unspecified, other bacterial infections of unspecified site, other seizures, local infection of the skin and subcutaneous tissue unspecified, iron deficiency, presence of cerebral spinal fluid drainage device, anemia unspecified, soft tissue disorder unspecified, unspecified visual loss, and gastroesophageal reflux disease [heartburn] without esophagitis [inflammation of the esophagus].Review of Resident #1's physician order dated 9/8/2025 read, Vancomycin HCl [Hydrocholoride, a potent antibiotic used to treat severe bacterial infections, including those resistant to other antibiotics] intravenous solution 1500mg/300ml [1500 milligrams in 300 milliliters of sodium chloride] Use 1500 mg intravenously every 8 hours for Infection for 21 Days.Review of Resident #1's physician order dated 9/8/2025 read, Cefepime HCI (antibiotic used to treat a wide variety of serious bacterial infections) intravenous solution 1 gm/50 ml [1 gram per 50 milliliter] (Cefepime HCI (hydrochloride)) Use 1 gram intravenously every 8 hours for infection for 21 Days until finished. Review of Resident #1's Medication Administration Record for the month of September 2025 for vancomycin 1500 mg intravenously was documented as chart code 9 (other see nurses notes) on 9/9/2025 at 0800 (8:00 AM) and 1600 (4:00 PM), on 9/10/2025 there is an X [not given] at 12:00 midnight and a chart code of 9 at 0800 [8:00 AM] and 1600 (4:00 PM). On 9/11/2025 a chart code of H [hold] at 1200 [12:00 AM], 0800, and 1600 for a total of 8 missed doses of vancomycin.Review of Resident #1's EMAR (electronic medication administration record) note for vancomycin 1500 mg IV dated 9/9/2025 at 7:32 AM read, order needs to be updated.Review of Resident #1's EMAR note for vancomycin 1500 mg IV dated 9/9/2025 at 4:21 PM read, will be in on evening run per pharmacy.Review of the form titled [Name of pharmacy] Inventory on Hand dated 9/9/2025 documented vancomycin 1 gm [gram] vial on hand amount 4 vials were in the [name of the automated medication dispensing machine].Review of Resident #1's EMAR note dated 9/10/2025 at 12:28 PM read, Vancomycin HCl intravenous solution 1500 mg/300 ml use 1500 mg intravenously every 8 hours for Infection for 21 Days. The pharmacy sent a malfunctioning pump, and the writer reached out to inform them of the issue. The pharmacy stated that the problem would be addressed during the next run. The NP [nurse practitioner] was notified and confirmed it was okay to put the medication on hold until then.Review of Resident #1's MAR for cefepime dated 09/9/2025 at 6:00 AM documented a code of 5 (Hold/see Nurses Notes) and 1400 (2:00 PM) a code of 9 (Other/See Nurses Notes). For a total of two missed doses.Review of Resident #1's MAR dated 09/10/2025 at 6:00 AM, 2:00 PM, and 10:00 PM documented cefepime was administered. Vancomycin for the date of 9/10/2025 documented at 12:00 midnight X (not administered), at 8:00 AM and 4:00 PM code 9 (Other/see Nurse Notes).Review of Resident #1's physician progress note dated 9/10/2025 at 13:23 (1:23 PM), authored by APRN #1 (Advanced Practitioner Registered Nurse), read, He has now been admitted to the skilled nursing facility for continuation of IV vancomycin and cefepime, wound care management, and rehabilitation support. Assessment/Plan: Chronic osteomyelitis, unspecified site with recent surgical intervention. Active, high-risk condition. Patient with recurrent osteomyelitis, currently on IV vancomycin and cefepime per infectious disease recommendations. Plan: Continue IV vancomycin and cefepime per protocol. Monitor temperature, WBC [white blood cell] trends, renal function, and vancomycin trough levels. Maintain coordination with infectious disease and wound care teams.Review of Resident #1's eInteract SBAR (Situation, Background, Assessment, Recommendation) dated 9/11/2025 at 3:33 PM read, Situation: The Change In Condition/s reported on this CIC Evaluation are/were: Altered mental status. Outcomes of Physical Assessment: Positive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 4 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few findings reported on the resident/patient evaluation for this change in condition were: Mental Status Evaluation: Altered level of consciousness. Neurological Status Evaluation: Altered level of consciousness. Primary Care Provider Feedback: Primary Care Provider responded with the following feedback: A. Recommendations: cbc [complete blood count], cmp [complete metabolic profile] vanco [vancomycin] trough [a blood test used for monitoring the vancomycin medication administration). Review of Resident #1's physician order dated 9/11/2025 read, CBC w/ Diff [differential], comprehensive panel/vancomycin pre-dose (trough) one time only related to presence of cerebrospinal fluid drainage device, iron deficiency, other seizures, local infection of the skin and subcutaneous tissue, unspecified anemia, unspecified, other hydrocephalus, subacute osteomyelitis, other site, soft tissue disorder, unspecified, other bacterial infections of unspecified site, spina bifida occulta. Review Resident #1's Laboratory result report with specimen collection date of 9/11/2025 and report date of 9/12/2025 read, Vancomycin trough final result <2.0 [less than] ug (micrograms)/ml (milliliter) (L) (low) - Ref. [reference] Range Units: 5.0 - 20.0 ug.Review of Resident #1's eInteract Transfer Form dated 9/12/2025 at 10:16 AM read, Section A: Demographic and Transfer information: 2. Transfer/discharge details. Send to [Name of local hospital], sent from [Name of Nursing home]. Reason(s) for transfer: other; Other reason for transfer: possible sepsis.Review of Resident #1's nursing progress note dated 9/12/2025 at 10:38 AM read, At approximately 10:00 AM**, the writer received a call from the resident's mother, who requested that the resident be sent to the hospital for further evaluation due to concerns about possible sepsis. VS [vital signs] 123/81 p [pulse]107 T [temperature] 98.8 02 [oxygen saturation] 98 alert and oriented x 2 with confusion have no recall of short-term memory. The NP [Nurse Practitioner] on site was notified. The resident's mother was informed of the transfer to the hospital. The DON [Director of Nursing] was also notified. The plan of care remains ongoing.Review of Resident #1's eInteract SBAR dated 9/12/2025 at 10:28 AM read, Situation: The Change In Condition (CIC)/s reported on this CIC Evaluation are/were: Other change in condition. Primary Care Provider Feedback: Primary Care Provider responded with the following feedback: A. Recommendations: send out for further evaluation.Review of Resident #1's medical record from [Name of Hospital] titled ‘ED [Emergency Department] to Hosp [Hospital]- admission (Current) dated 9/12/2025 read, ED course & re-evaluation: [Resident #1's name], a [AGE] year-old male with a PMHx [past medical history] of spina bifida occulta with hydrocephalus [a buildup of fluid in the brain] s/p [status post] [NAME] rod [a stainless steel surgical device used to treat a curvature of the spine] and VP [ventriculoperitoneal] shunt [a tube in the brain to drain fluid into the stomach], paraplegia, paralysis (the loss of the ability to move certain parts of the body typically as a result of illness or injury) below T8 [thoracic nerve number 8] + chronically wheelchair bound and chronic sacral wound, who presents today from outside skilled facility with AMS [altered mental status], tachycardia [a high heart rate], and concerns for sepsis [a life threatening emergency that damages the body's organs and can cause death] w [with]/new onset of leukocytosis [an abnormally high number of white blood cells (leukocytes) in the bloodstream] of 15 [indicates the body is fighting an infection]. On arrival, he was tachycardic [related to a high heart rate] but hemodynamically stable [a state in which the cardiovascular system is functioning properly and maintaining adequate blood flow throughout the body]. He was sepsis alerted given concern for infection and initial tachycardia with leukocytosis at outside facility. He was started on Vancomycin, cefepime and 30 cc [cubic centimeters]/kg [kilogram] IVF [intravenous fluids] with source concerning for recurrent osteomyelitis [an infection of the bone] and possible abscess [a pocket of pus] at recent surgical site in the setting of subtherapeutic [low level that is too low to produce the intended medical effect] Vancomycin + [plus] missing antibiotic dose. Regarding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 5 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few his AMS [altered mental status], his mother noted repetitive questioning and confusion otherwise no new neurologic deficits. His VP shunt is compressible. Will further evaluate additional causes of AMS with labs and imaging. Anticipate admission. ED [Emergency Department] Clinical Impression: Osteomyelitis of left femur, unspecified type, septic hip s/p [NAME] procedure, abscess of hip, left, sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present, acute encephalopathy [a disturbance in brain function that causes confusion and memory loss].Review of Resident #1 [Name of Hospital] medical record titled History and Physical dated 9/12/2025 read, [Resident #1's name] is a 39 y.o. [year old] male with medical history significant for spina bifida occulta with hydrocephalus s/p VP shunt and [NAME] spinal rod placement, paraplegia and chronically wheelchair bound admitted for altered mental status secondary to sepsis from acute on chronic osteomyelitis of the left hip. The patient was recently hospitalized from 8/11-9/8/2025 for sepsis secondary to acute on chronic osteomyelitis and underwent a [NAME] procedure. He was then discharged to SNF [skilled nursing facility] for rehabilitation and continued IV antibiotic course for treatment of his acute infection. He has now been brought back to the ED due to altered mental status. He is currently accompanied by his mother who is at bedside. She states that the patient has been at the facility for several days since being discharged with IV antibiotics, however she has been concerned as she does not believe he has been receiving these medications or at least on a reliable schedule. She states that he began to act abnormal yesterday at which time he had completely forgotten the fact that he had just been hospitalized for two weeks. Today is alert and oriented only to self. He struggles with location, year, and current president. On arrival to the ED, the patient was found to be afebrile [not having a fever] with vitals remarkable for sinus tachycardia. Labs are remarkable for leukocytosis (WBC 15) and elevated CRP [C-Reactive Protein, indicative of inflammation in the body] (21.14). CT [Computed Tomography] imaging has revealed acute on chronic osteomyelitis of the left hip with details concerning for septic joint formation. There is also noted to likely be subperiosteal abscess (infection to the tissue located the surface of the bones) formation along the medical margin of the femoral head with a communicating sinus tract to the posterior medial skin of the left proximal thigh. Assessment and plan: [Resident #1's name] is a 39 y.o. male who is admitted for altered mental status secondary to sepsis from acute on chronic osteomyelitis of the left hip. Active Problems: #Sepsis, reason for admission, #Acute on Chronic Osteomyelitis, #Altered Mental Status, resolved - admitted for sepsis secondary to acute on chronic osteomyelitis that has likely worsened secondary to poor wound care lack of proper antibiotic usage.Review of Resident #1 [Name of Local Hospital] Infectious Disease note dated 9/13/2025 read, [Resident #1's name] is a 39 y.o. male with above mentioned PMHx admitted on [DATE] with chief complaint of altered mental status 1 day prior to admission. Recently admitted 8/11-9/8 for acute on chronic osteomyelitis of L [left] ischium, was planned for Flagyl (8/19-9/1), Vancomycin (8/19-9/29), and Cefepime (8/19-9/29). Underwent debridement during this time (see above). Unfortunately, the patient may not have received his antibiotics in an appropriate manner and may be contributory to the patient's current presentation. He currently complains of a 1/2 [one out of two] pain around his incision site and around his L AC [antecubital] (about 4 inches away from his PICC [Peripherally Inserted Central Catheter] line). He doesn't remember being at [Name of local hospital] recently and cannot tell but is able to talk about some specific details about his life.During an interview on 10/07/2025 at 1:36 PM, Staff A, Licensed Practical Nurse (LPN), stated, [Resident #1's name] had been transferred from another room during my shift [9/9/2025]. [Name of Staff B] had [Resident #1's name] prior to me and had called pharmacy who said they would be bringing his medication [vancomycin]. I called the pharmacy again and the pharmacy said they were enroute with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 6 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few medication. I called the nurse practitioner; I believe her name is [APRN #1's name]. She [APRN #1] told me to extend the order for vancomycin for an extra day, so [Resident #1's name] would have the full course of the antibiotics. The pharmacy courier came in around 7:05 [PM] and brought me his medications. I passed them on to the night shift nurse because it was getting late. I don't think I wrote a note because I was in a rush to leave. I believe I should have documented the conversation with [name of APRN #1]. I don't know really if I can give the medication without a pump and I think that there is vancomycin in the [name of the automated medication dispensing machine]. I don't think we can ask for a stat [derived from the Latin word statim, meaning immediately] delivery from the pharmacy.During an interview on 10/07/2025 at 1:38 PM, Staff B, LPN stated, [Resident #1's name] was an admission from the day before [9/8/2025]. The night-shift nurse [Staff E, LPN] told me that the nurse who admitted the resident did not put in [Resident #1's name] medication orders, so [Staff E's name] was not able to administer any medications for him. I can't remember if she called a provider, but I thought she had gotten an order to hold the vancomycin. If the medication was available in the [name of the automated medication dispensing machine] it should be administered. I know I should have notified the provider of the missed medications, and I should have documented the notification and any orders or instructions from the provider. I'm not sure if we can do a stat order from the pharmacy, we just regularly call the pharmacy and tell them we are waiting for the medication.During an interview on 10/07/2025 at 3:20 PM Staff E, LPN stated, Most of [Resident #1's name] medications were not available on the night shift of 9/8/25 - 9/9/25. The pharmacy doesn't come to the facility until 6:00 AM. Medication orders are typically entered to start the following day [after admission] because of the delivery times from the pharmacy, but [Resident #1's name] medications were ordered to start on the day of his admission [DATE]]. For the medications that were scheduled for my shift I was able to administer his cefepime because it was available in the [name of automated medication dispensing machine]. There was not a dose of vancomycin in the [name of automated medication dispensing machine] but there was overflow of vancomycin in the med [medication] room, as well as an overflow pump, so I was able to administer the ordered dose of vancomycin. I was not able to administer the morning dose of cefepime. I might have notified the doctor that I could not give the cefepime, but I am not sure. I did notify management that I did not give the cefepime, but I did not document the notification because I was already off of the [medication] cart. I know I should have written a note. Review of a form titled [Name of Pharmacy Provider] Transactions by Patient date 9/8/2025 documented vancomycin 1 gm one vial was removed at 7:50 PM, cefepime 1 gm two vials were removed, one at 7:49 PM and one at 7:53 PM. One bag of sodium chloride inj (injectable) 100 ml was removed at 7:55 PM from the [name of the automated medication dispensing machine] for [Resident #1's name]. Additional interviews were attempted 10/8/2025 and 10/9/2025 with Staff E, LPN via telephone to provide clarification of the removal of 100 ml of sodium chloride and vancomycin 1 gram and two vials of cefepime and no additional sodium chloride removed from the automated medication dispensing machine for vancomycin and cefepime IV administration. The physician orders document vancomycin 1500 mg (1.5 grams) in 300 ml of sodium chloride and cefepime in 50 ml of sodium chloride. On the date of the exit, 10/10/2025, no return call was received.Review of the Ad Hoc (originally comes from Latin that means for this specific purpose, indicating the actions or solutions designed for a specific problem or situation) Quality Assurance & Performance Improvement Meeting dated 10/8/2025 documented, Data: Nurse removed 2 IV meds from [name of automatic medication dispensing machine], right med, wrong dose and administered. Root Cause Analysis: Nurse did not have medication that was due in her cart or med room and it had not been delivered from pharmacy. Medication removed from [name of automatic medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 7 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few dispensing machine] right med but wrong dosage and dosage not verified before administration.Review of an email from Staff E, LPN addressed to Staff K, Previous Interim DON, dated 9/15/2025 at 4:41 PM read, On admission, resident [Resident #1] was ordered vancomycin and cefepime IV. Medications were not on hand but were available in [name of the automatic medication dispensing machine]. MAR reflected both medications scheduled for administration around 2100 [9:00 PM] on 9/8 [2025]. Cefepime was administered IV first, followed by vancomycin. Vancomycin infusion was prolonged due to patient's arm being constricted, which intermittently stopped the infusion. At 0600 [6:00 AM] on 9/9 [2025], MAR again showed scheduled doses for both vancomycin and cefepime. Unable to administer at that time because the vancomycin infusion from the previous evening was still running. Also, when the medications were delivered from the pharmacy, only the vancomycin was supplied; cefepime was not included in the delivery. This information was passed on in report with recommendation that administration times for vancomycin and cefepime be adjusted accordingly.Review of an email from Staff A, LPN addressed to Staff K, Previous Interim DON dated 9/17/25 at 8:28 AM read, To whom it may concern: I was [Resident #1's name] nurse for a very short period of time of roughly 2 - 3 hours on September 9th [2025] after he moved from room [room number] to [room number]. During that time I asked the nurse who had him at the beginning of the day if he had his 4:00 PM dose of vancomycin and she said no, it was not delivered. I called the pharmacy to confirm and they stated the medication was on the evening medication delivery. As such, I contacted one of the providing APRN's of the situation and got orders to extend dose of antibiotics for another day. I changed the order to extend so that once the antibiotic was delivered, he would get the full course of his antibiotic treatment. During shift change, the pharmacy delivery with [Resident #1's name] medication came along with the pump and I was also the one who signed for those, and I relayed the information to the oncoming shift.During an interview on 10/7/2025 at 4:10 PM, Staff C, Pharmacy Account Manager stated, I am not familiar with the facility having any overflow medications or overstock of antibiotics, and the pharmacy does not leave extra IV pumps at the facility. For a resident admitted to the facility on a Monday at or around 5:00 PM, the medications would have been delivered the following morning. We do have a process for stat deliveries, and we would have routinely delivered within three and a half to four hours when ordered stat. During an interview on 10/07/2025 at 4:20 PM, Staff D, Lead Pharmacist stated, We make two deliveries to the facility daily. The deliveries leave the pharmacy at 2:00 PM and 2:00 AM, and then the deliveries arrive at the facility between 6:00 PM and 7:00 AM. I do not have knowledge of overflow or overstock medications. It was not part of the standard protocol for the pharmacy to supply any medications for general use outside of what was in the [name of the automated medication dispensing machine]. There are no extra IV pumps supplied to the facility. The facility can get a stat delivery from the pharmacy. For any medication ordered stat, we begin working on them as soon as we receive the order. The turnaround time for stat orders is four hours. If an IV pump was malfunctioning a replacement pump could be ordered stat. Vancomycin should be provided through an infusion pump to ensure proper administration and prevention of complications from administering to rapidly such as RMS [Red Man Syndrome, a type of allergic reaction that can occur with vancomycin administration] which typically could occur if vancomycin is infused too rapidly. We generally have orders to monitor vancomycin and manage the medication. Ideally in monitoring we are evaluating the Vanco [vancomycin] trough and adjusting doses from there, anything less than 10 is associated with higher levels of antibiotic resistance, ideally we attempt to maintain levels between 10-20 for optimal effect to maintain the drugs efficacy and minimize nephro [nephrotoxicity-damage to the kidneys] and ototoxicity toxicity [damage to hearing].During an interview on 10/8/2025 at 8:55 AM, APRN #1 [Advanced Practice (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 8 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Registered Nurse] stated, I saw [Resident #1's name] on 9/10/2025. I did not receive a call prior to my visit regarding the resident [Resident #1] or any issues with his antibiotics. I was asked by a facility nurse on 9/10/2025 if [Resident #1's name] vancomycin could be held because it was not available in the facility, but I believed the hold was not necessary as he was receiving his antibiotic infusion when I was in his room on 9/10/2025. I would give an order to hold antibiotics for one dose if the medications were on their way to the facility from the pharmacy. If it was more than one dose, I know what the resident was receiving in the hospital and that the medication was available in the facility. So, I would have given an order for that antibiotic to be given, or I would have determined if there was another medication available in the facility that I could order. I only recall speaking with a nurse regarding [Resident #1's name] on 9/10/2025 prior to seeing him. I do not recall speaking with anyone regarding a malfunctioning IV pump or giving orders to hold his vancomycin related to the issues with the IV pump. During an interview on 10/8/2025 at 9:25 AM, the Director of Nursing (DON) stated, When a resident is admitted the process is to get the orders in the computer so pharmacy can get them delivered. If the medications are not available, the nurses need to contact the physician. The nurses should contact the pharmacy and ask about getting medications from the [name of the automated medication dispensing machine] or ask for a stat delivery. There were also sister pharmacies they can contact for getting medications if there is a problem. We do have sister facilities they can call to get an IV pump. If medications are not in the facility for administration the nurses need to call the doctor and follow the physician's orders and document the process. The nurses should ask the doctor if there is an alternative medication they can give. The reasonable time frame for a nurse to wait on medications is an hour. If they were unable to administer an ordered antibiotic to a resident, the resident should be sent to the hospital. I have concerns regarding the competence of the facility nurses.During an interview on 10/08/2025 at 9:50 AM, the Medical Doctor stated, I do not recall being contacted regarding the resident [Resident #1] or any issues with his antibiotics. It was unfortunate that the resident did not receive his ordered antibiotics and of his readmission to the hospital. Residents have got to get the medications ordered for them. It is a shame that they were not administered, they should have been given. I'm aware that [missed doses of IV antibiotics] would cause concern for his admission for sepsis, not getting the medication may be a concern.During an interview on 10/08/2025 at 10:59 AM, APRN #2 stated, I got a message on 9/9/25 at 6:43 PM requesting that [Resident #1's name] vancomycin schedule be extended due to him missing a dose. I instructed the nurse to contact the pharmacy regarding the dosing of vancomycin. I was contacted only one time regarding only one missed dose of vancomycin. I would have only ordered the vanco to be held for one dose.During an interview on 10/08/2025 at 11:50 AM, Resident #1's mother stated, My son [Resident #1] is still in the hospital due to the bacteria he tested positive for when he was readmitted , and that he had to be on antibiotics for twelve hours out of every twenty-four. [Resident #1's name] had not received his vancomycin while he was in the facility, and I received conflicting information from the staff regarding the reason it was not being administered. [Resident #1's name] called me on 9/11/25 and told me that he did not know what was happening and he was confused. I was concerned about his altered mental status, and I called the Unit Manager in the facility to report my concerns. I was told that the nursing staff had not noticed any changes in his condition, but they would obtain labs. On 9/12/25 at around 2:00 PM [Resident #1's name] called me and told me he did not know where he was. I called the facility, reported my concerns and requested that he be transferred to the hospital.During an interview on 10/09/2025 at 8:05 AM, Staff G, LPN stated, I do not remember how many doses of vancomycin [Resident #1's name] had been scheduled during my shift on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 9 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 9/10/2025. I was not able to administer the IV vancomycin because the IV pump was malfunctioning. I called the pharmacy and was told that the pharmacy had to receive the malfunctioning pump back before they would send a replacement IV pump. I spoke with the in-house nurse practitioner, [Name of APRN #1], who was in the building at that time. The nurse practitioner gave an order to hold the vanco, but I don't remember if the NP [nurse practitioner] said to hold the vanco for one dose or for one day. On 9/11[2025] there was a stat lab to check his vancomycin level. I had a conversation with a provider regarding the results of the vanco level and it would have been [APRN #1's name] I would have called. I can't remember if I told [APRN #1's name] that the pump was still not there. I called the pharmacy again regarding the IV pump and was told the pump would be delivered that day. The pump arrived before the end of my shift on the day before he went to the hospital. During an interview on 10/09/2025 at 10:37 AM the Administrator stated, Nurses are educated in orientation regarding medication administration and the associated processes, including ordering medications and equipment from the pharmacy. The expectation was that when a resident was admitted their medication orders were sent to the pharmacy. The facility had previously had issues regarding medication availability and administration, and it was a topic they all focused on. The process with the pharmacy was to deliver the medications and any equipment on their next run. If medication was not available from the pharmacy, the nurses had access to the [name of automated medication dispensing machine] and the pharmacy was able to get medications from a sister pharmacy if necessary. During an interview on 10/10/2025 at 2:06 PM with the DON when asked regarding the significant medication errors related to the administration of vancomycin and cefepime for Resident #1 the DON stated, I am new to the facility. I wasn't here when this hap Event ID: Facility ID: 105460 If continuation sheet Page 10 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 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 Based on observation, interview, and record review, the facility failed to ensure midline and central venous access device dressings and flushing were completed according to professional standards of practice for 2 of 3 residents reviewed for intravenous therapy (Residents #3 and #4).Findings include: 1. Review of Resident #3's admission record documented an admission date of 9/25/2025 with diagnoses to include other acute osteomyelitis (an infection of the bone) left ankle and foot, type 2 diabetes mellitus with unspecified complications, acquired absence of left leg below knee, depression unspecified, and unspecified sequela of cerebral infarction (a stroke).Review of Resident #3's physician order dated 10/2/2025 read, May place midline [a midline catheter] for IV [intravenous] antibiotics with Lidocaine if needed.Review of Resident #3's physician order dated 10/3/2025 read, Change dressing on admission or 24 hours after insertion and weekly thereafter and PRN [as needed]. Change dressing as needed and every day shift every Tue [Tuesday] Change dressing weekly.During an observation on 10/7/2025 at 9:15 AM, Resident #3 had a left upper arm single lumen midline catheter with a dressing that was dated 10/3/2025 and gauze under the transparent dressing preventing the insertion site from being observed.During an interview on 10/7/2025 at 9:15 AM, Resident #3 stated, I am getting antibiotics for an infection. I got that IV line a few days ago. The dressing hasn't been changed yet.Review of Resident #3's medical record did not contain documentation of a midline catheter insertion or dressing change 24 hours after insertion of the midline catheter.During an interview on 10/7/2025 at 9:45 AM, Staff B, Licensed Practical Nurse (LPN), stated, It [the midline catheter] has been in since Thursday or Friday [10/2/2025 or 10/3/2025]. The dressing does have gauze under it, and it should have been changed before now.During an observation on 10/8/2025 at 10:15 AM, Staff L, LPN, performed hand hygiene and donned a gown and gloves to administer medications via IV to Resident #3. Staff L cleansed the needleless connector with alcohol. Staff L failed to check the IV patency and position, and administered 10 milliliters (ml) of 0.9% normal saline, and connected the IV antibiotic medication, doffed the gown and gloves, and performed hand hygiene.During an interview on 10/8/2025 at 10:25 AM, Staff L, LPN, stated, I should have checked for a blood return [this indicates the catheter is in the vein]. I should have tried to do that. I think I gave the normal saline fine.2. Review of Resident #4's admission record documented an admission date of 10/4/2025 with diagnoses to include other streptococcal arthritis left knee, pain in left knee, laceration without foreign body left knee subsequent encounter, localized edema and muscle weakness.Review of Resident #4's physician order dated 10/4/2025 read, Change dressing on admission or 24 hours after insertion and weekly thereafter and PRN every day shift every Tue.During an observation on 10/7/2025 at 9:25 AM, Resident #4 was in bed and had a left upper arm single lumen peripherally inserted central catheter (PICC) line. The dressing was dated 9/29/2025.Review of Resident #4's medication administration record (MAR) for October 2025 documented the dressing change was completed on 10/4/2025 at 1724 (5:24 PM).During an interview on 10/7/2025 at 9:30 AM, Staff B, LPN, stated, The dressing date is showing 9/29/2025 and should have been changed.During an interview on 10/8/2025 at 10:15 AM, Staff G, LPN, stated, I did not do the dressing. I should have done it. I should not have documented that I did it.Review of the policy and procedure titled Catheter Insertion and Care: Midline Dressing Changes with an effective date of 1/17/2019 and the last approval date of 2/7/2025 read, Policy: Midline catheter dressings will be changed at specific intervals, or when needed, to prevent catheter-related infections associated with contaminated, loosened or soiled catheter-site dressings. General Guidelines: 1. Change midline catheter dressings 24 hours after insertion, every 5-7 days, or if it is wet, dirty, not intact, or compromised in any way. 4. Use a sterile transparent, semi-permeable membrane (TSM) or gauze Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 11 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete dressing. If gauze dressing is used, cover the gauze with a TSM and change the dressing every 48 hours.Review of the policy and procedure titled Flushing Central Venous and Midline Catheters with an effective date of 1/17/2019 and the last approval date of 2/7/2025 read, Policy: Midline and central line access devices (CVADs) [Sic.] will be flushed to maintain patency, prevent mixing of incompatible medications and solutions; and to ensure entire dose of solution or medication is administered into the venous system. General Guidelines: Flushing Technique: 2. Use a push-pause or pulsing motion for flushing technique. 3. Aspirate the CVAD catheter for blood to confirm patency prior to administration of medications and solutions. Procedure: Flushing when giving medications: 6. Aspirate slowly for blood return to ensure patency of catheter. 7. Flush with normal saline (amount established by pharmacy of facility protocol) using push-pause method.Review of the policy and procedure titled Catheter Insertion and Care: Central Venous Catheter Dressing Changes with an effective date of 1/17/2019 and the last approval date of 2/7/2025 read, Policy: Central venous catheter dressings will be changed at specific intervals, or when needed, to prevent catheter-related infections associated with contaminated, loosened or soiled catheter-site dressings. General Guidelines: 2. Change transparent semi-permeable membrane (TSM) dressings at least every 5-7 days and PRN (when wet, soiled, or not intact). Event ID: Facility ID: 105460 If continuation sheet Page 12 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure 2 of 6 reviewed licensed practical nurses (Staff H, and Staff J) had the specific competency requirements as part of their license and certification to administer IV (intravenous) medications, and 4 of 6 reviewed licensed practical nurses (Staff A, Staff B, Staff E, and Staff G) failed to follow the policy/procedure related to IV medication administration, physician notification, and obtaining stat [derived from the Latin word statim, meaning immediately] orders for medication and equipment for 3 of 3 residents reviewed for intravenous antibiotic medication (Residents #1, #3, and #4), the facility failed to ensure 4 of 6 licensed practical nurses (Staff A, Staff B, Staff J, and Staff L) failed to follow physician-ordered parameters for blood pressure medications for 1 of 3 residents reviewed for medication administration (Resident #2). The facility failure to ensure the nursing staff had appropriate IV (intravenously) certification to administer IV medications and followed the policy/procedure related to medication administration, physician notification, and obtaining stat orders for medication and equipment resulted in Immediate Jeopardy. Resident #1 was admitted on [DATE] with physician orders for Vancomycin 1500 mg IV every 8 hours intravenously for infection (osteomyelitis, an infection in the bone). On 9/8/2025 at approximately 10:00 PM, Resident #1 was administered one incorrect dose of Vancomycin 1000 mg. Resident #1 was not administered any further doses of Vancomycin 1500 mg until 9/12/2025 at 12:00 AM. Resident #1 missed 8 doses of Vancomycin between 9/9/2025 and 9/12/2025. On 9/11/2025, Resident #1 began to experience a change in condition of altered mental status, identified by a family member, who requested on 9/12/2025, that Resident #1 be sent to Emergency Department where he was diagnosed with sepsis [a life threatening emergency that damages the body's organs and can cause death]. Missing antibiotic doses can reduce the effectiveness of the treatment and increase the risk of antibiotic resistance, serious harm and/or death, and lack of staff competency related to nursing staff having appropriate IV certification, can result in serious harm including damage to veins and the injection site, an air embolism, phlebitis, and blood clots, injury and/or death.The Administrator was notified of the Immediate Jeopardy on October 10, 2025, at 11:45 AM.Findings include: 1) Review of Resident's #1's Discharge summary dated [DATE] from [Name of local hospital] read, Outpatient IV ABX (antibiotic) orders: 2. Vancomycin 1500 mg [milligrams] q8h [every eight hours] for 2 weeks.Review of Resident #1's admission record documented an admission date of 9/8/2025 with diagnoses to include subacute osteomyelitis [an infection in the bone], other site, spina bifida occulta [a small gap in one or more of the bones in the spine], other hydrocephalus [a buildup of fluid in the brain], paraplegia (an impairment in motor or sensory function of the lower extremities) unspecified, other bacterial infections of unspecified site, other seizures, local infection of the skin and subcutaneous tissue unspecified, iron deficiency, presence of cerebral spinal fluid drainage device, anemia unspecified, soft tissue disorder unspecified, unspecified visual loss, and gastroesophageal reflux disease [heartburn] without esophagitis [inflammation of the esophagus].Review of Resident #1's nursing progress note dated 9/8/2025 at 8:31 PM read, Patient was coming around 4:15 PM. With colostomy on his left side and a urostomy on his left side. PICC [Peripherally Inserted Central Catheter] line on his right arm. Vital signs was {sic} within normal range. Patient got left hip surgery paraplegic and had a drain in the space of the surgery. Patient is alert and oriented times 4.Review of Resident #1's physician order dated 9/8/2025 read, Vancomycin HCl [Hydrocholoride, a potent antibiotic used to treat severe bacterial infections, including those resistant to other antibiotics] intravenous solution 1500mg/300ml [1500 milligrams in 300 milliliters of sodium chloride] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 13 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Use 1500 mg intravenously every 8 hours for Infection for 21 Days.Review of Resident #1 Medication Administration Record for the month of September 2025 for Vancomycin 1500 mg intravenously was documented as being administered on 9/8/2025 at or around 2200 [10:00 PM] by Staff E., LPN.Review of Resident #1's Medication Administration Record for the month of September 2025 for vancomycin 1500 mg intravenously was documented as chart code 9 (other see nurses notes) on 9/9/2025 at 0800 (8:00 AM) and 1600 (4:00 PM), on 9/10/2025 there is an X [not given] at 12:00 midnight and a chart code of 9 at 0800 [8:00 AM] and 1600 (4:00 PM). On 9/11/2025 a chart code of H [hold] at 1200 [12:00 AM], 0800, and 1600 for a total of 8 missed doses of vancomycin.Review of Resident #1 Medication Administration Record for the month of September 2025 for Vancomycin HCI Intravenous Solution 1500mg documented on 9/12/2025 at 0000 [12:00 AM] administered by Staff J, LPN (Licensed Practical Nurse).Review of Resident #1's EMAR (electronic medication administration record) note for vancomycin 1500 mg IV dated 9/9/2025 at 7:32 AM read, order needs to be updated.Review of Resident #1's eMar note dated 9/9/2025 at 16:21 [4:21 PM]: Vancomycin 1500 mg IV read, Will be in on evening run per pharmacy.Review of Resident #1's EMAR note dated 9/10/2025 at 12:28 PM read, Vancomycin HCl intravenous solution 1500 mg/300 ml use 1500 mg intravenously every 8 hours for Infection for 21 Days. The pharmacy sent a malfunctioning pump, and the writer reached out to inform them of the issue. The pharmacy stated that the problem would be addressed during the next run. The NP [nurse practitioner] was notified and confirmed it was okay to put the medication on hold until then.Review of the form titled [Name of pharmacy] Inventory on Hand dated 9/9/2025 documented vancomycin 1 gm [gram] vial on hand amount 4 vials were in the [name of the automated medication dispensing machine].Review of Resident #1's physician order dated 9/8/2025 read, Cefepime HCI (antibiotic used to treat a wide variety of serious bacterial infections) intravenous solution 1 gm/50 ml [1 gram per 50 milliliter] (Cefepime HCI (hydrochloride)) Use 1 gram intravenously every 8 hours for infection for 21 Days until finished. Review of Resident #1's Medication Administration Record (MAR) for the month of September 2025 for cefepime 1 gm intravenously was documented as being administered on 9/8/2025 at or around 2200 (10:00 PM) by Staff E, LPN.Review of Resident #1's MAR for the month of September 2025 for cefepime HCI intravenous 1 gram documented on 9/10/2025 at 2200 administered by Staff H, Licensed Practical Nurse (LPN), on 9/11/2025 at 2200 administered by Staff J, LPN, and on 9/12/2025 at 0600 (6:00AM) administered by Staff J, LPN.Review of Resident #1's physician order dated 9/8/2025 read, IVs [intravenous]: Flush PICC (10cc) [cubic centimeter] of normal saline every shift and as needed.Review of Resident #1's MAR for the month of September 2025 for IV flush documented on 9/10/2025 at 1200 (12:00 AM - midnight) administered by Staff H, LPN and on 9/11/2025 at 1200 administered by Staff J, LPN.Review of Resident #1's MAR for cefepime dated 09/9/2025 at 6:00 AM documented a code of 5 (Hold/see Nurses Notes) and 1400 (2:00 PM) a code of 9 (Other/See Nurses Notes). For a total of two missed doses.Review of Resident #1's MAR dated 09/10/2025 at 6:00 AM, 2:00 PM, and 10:00 PM documented cefepime was administered. Vancomycin for the date of 9/10/2025 documented at 12:00 midnight X (not administered), at 8:00 AM and 4:00 PM code 9 (Other/see Nurse Notes).Review of Resident #1's physician progress note dated 9/10/2025 at 13:23 (1:23 PM), authored by APRN #1 (Advanced Practitioner Registered Nurse), reads, He has now been admitted to the skilled nursing facility for continuation of IV vancomycin and cefepime, wound care management, and rehabilitation support. Assessment/Plan: Chronic osteomyelitis, unspecified site with recent surgical intervention. Active, high-risk condition. Patient with recurrent osteomyelitis, currently on IV vancomycin and cefepime per infectious disease recommendations. Plan: Continue IV vancomycin and cefepime per protocol. Monitor temperature, WBC [white blood cell] trends, renal function, and vancomycin trough levels. Maintain coordination with infectious disease and wound care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 14 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some teams.Review of Resident #1's eInteract SBAR (Situation, Background, Assessment, Recommendation) dated 9/11/2025 at 3:33 PM read, Situation: The Change In Condition/s reported on this CIC Evaluation are/were: Altered mental status. Outcomes of Physical Assessment: Positive findings reported on the resident/patient evaluation for this change in condition were: Mental Status Evaluation: Altered level of consciousness. Neurological Status Evaluation: Altered level of consciousness. Primary Care Provider Feedback: Primary Care Provider responded with the following feedback: A. Recommendations: cbc [complete blood count], cmp [complete metabolic profile] vanco [vancomycin] trough [a blood test used for monitoring the vancomycin medication administration). Review of Resident #1's physician order dated 9/11/2025 read, CBC w/ Diff [differential], comprehensive panel/vancomycin pre-dose (trough) one time only related to presence of cerebrospinal fluid drainage device, iron deficiency, other seizures, local infection of the skin and subcutaneous tissue, unspecified anemia, unspecified, other hydrocephalus, subacute osteomyelitis, other site, soft tissue disorder, unspecified, other bacterial infections of unspecified site, spina bifida occulta. Review Resident #1's Laboratory result report with specimen collection date of 9/11/2025 and report date of 9/12/2025 read, Vancomycin trough final result <2.0 [less than] ug (micrograms)/ml (milliliter) (L) (low) - Ref. [reference] Range Units: 5.0 - 20.0 ug.Review of Resident #1's eInteract Transfer Form dated 9/12/2025 at 10:16 AM read, Section A: Demographic and Transfer information: 2. Transfer/discharge details. Send to [Name of local hospital], sent from [Name of Nursing home]. Reason(s) for transfer: other; Other reason for transfer: possible sepsis.Review of Resident #1's nursing progress note dated 9/12/2025 at 10:38 AM read, At approximately 10:00 AM**, the writer received a call from the resident's mother, who requested that the resident be sent to the hospital for further evaluation due to concerns about possible sepsis. VS [vital signs] 123/81 p [pulse]107 T [temperature] 98.8 O2 [oxygen saturation] 98 alert and oriented x 2 with confusion have no recall of short-term memory. The NP [Nurse Practitioner] on site was notified. The resident's mother was informed of the transfer to the hospital. The DON [Director of Nursing] was also notified. The plan of care remains ongoing.Review of Resident #1's Interactive SBAR dated 9/12/2025 at 10:28 [10:28 AM] read, Situation: The Change In Condition (CIC)/s reported on this CIC Evaluation are/were: Other change in condition - Possible Sepsis. Primary Care Provider Feedback: Primary Care Provider responded with the following feedback: A. Recommendations: send out for further evaluationReview of Resident #1's medical record from [Name of Hospital] titled ‘ED [Emergency Department] to Hosp [Hospital]- admission (Current) dated 9/12/2025 read, ED course & re-evaluation: [Resident #1's name], a [AGE] year-old male with a PMHx [past medical history] of spina bifida occulta with hydrocephalus [a buildup of fluid in the brain] s/p [status post] [NAME] rod [a stainless steel surgical device used to treat a curvature of the spine] and VP [ventriculoperitoneal] shunt [a tube in the brain to drain fluid into the stomach], paraplegia, paralysis (the loss of the ability to move certain parts of the body typically as a result of illness or injury) below T8 [thoracic nerve number 8] + chronically wheelchair bound and chronic sacral wound, who presents today from outside skilled facility with AMS [altered mental status], tachycardia [a high heart rate], and concerns for sepsis [a life threatening emergency that damages the body's organs and can cause death] w [with]/new onset of leukocytosis [an abnormally high number of white blood cells (leukocytes) in the bloodstream] of 15 [indicates the body is fighting an infection]. On arrival, he was tachycardic [related to a high heart rate] but hemodynamically stable [a state in which the cardiovascular system is functioning properly and maintaining adequate blood flow throughout the body]. He was sepsis alerted given concern for infection and initial tachycardia with leukocytosis at outside facility. He was started on Vancomycin, cefepime and 30 cc [cubic centimeters]/kg [kilogram] IVF [intravenous (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 15 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some fluids] with source concerning for recurrent osteomyelitis [an infection of the bone] and possible abscess [a pocket of pus] at recent surgical site in the setting of subtherapeutic [low level that is too low to produce the intended medical effect] Vancomycin + [plus] missing antibiotic dose. Regarding his AMS [altered mental status], his mother noted repetitive questioning and confusion otherwise no new neurologic deficits. His VP shunt is compressible. Will further evaluate additional causes of AMS with labs and imaging. Anticipate admission. ED [Emergency Department] Clinical Impression: Osteomyelitis of left femur, unspecified type, septic hip s/p [NAME] procedure, abscess of hip, left, sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present, acute encephalopathy [a disturbance in brain function that causes confusion and memory loss].Review of Resident #1 [Name of Hospital] medical record titled History and Physical dated 9/12/2025 read, [Resident #1's name] is a 39 y.o. [year old] male with medical history significant for spina bifida occulta with hydrocephalus s/p VP shunt and [NAME] spinal rod placement, paraplegia and chronically wheelchair bound admitted for altered mental status secondary to sepsis from acute on chronic osteomyelitis of the left hip. The patient was recently hospitalized from 8/11-9/8/2025 for sepsis secondary to acute on chronic osteomyelitis and underwent a [NAME] procedure. He was then discharged to SNF [skilled nursing facility] for rehabilitation and continued IV antibiotic course for treatment of his acute infection. He has now been brought back to the ED due to altered mental status. He is currently accompanied by his mother who is at bedside. She states that the patient has been at the facility for several days since being discharged with IV antibiotics, however she has been concerned as she does not believe he has been receiving these medications or at least on a reliable schedule. She states that he began to act abnormal yesterday at which time he had completely forgotten the fact that he had just been hospitalized for two weeks. Today is alert and oriented only to self. He struggles with location, year, and current president. On arrival to the ED, the patient was found to be afebrile [not having a fever] with vitals remarkable for sinus tachycardia. Labs are remarkable for leukocytosis (WBC 15) and elevated CRP [C-Reactive Protein, indicative of inflammation in the body] (21.14). CT [Computed Tomography] imaging has revealed acute on chronic osteomyelitis of the left hip with details concerning for septic joint formation. There is also noted to likely be subperiosteal abscess (infection to the tissue located the surface of the bones) formation along the medical margin of the femoral head with a communicating sinus tract to the posterior medial skin of the left proximal thigh. Assessment and plan: [Resident #1's name] is a 39 y.o. male who is admitted for altered mental status secondary to sepsis from acute on chronic osteomyelitis of the left hip. Active Problems: #Sepsis, reason for admission, #Acute on Chronic Osteomyelitis, #Altered Mental Status, resolved - admitted for sepsis secondary to acute on chronic osteomyelitis that has likely worsened secondary to poor wound care lack of proper antibiotic usage.Review of Resident #1 [Name of Local Hospital] Infectious Disease note dated 9/13/2025 read, [Resident #1's name] is a 39 y.o. male with above mentioned PMHx admitted on [DATE] with chief complaint of altered mental status 1 day prior to admission. Recently admitted 8/11-9/8 for acute on chronic osteomyelitis of L [left] ischium, was planned for Flagyl (8/19-9/1), Vancomycin (8/19-9/29), and Cefepime (8/19-9/29). Underwent debridement during this time (see above). Unfortunately, the patient may not have received his antibiotics in an appropriate manner and may be contributory to the patient's current presentation. He currently complains of a 1/2 [one out of two] pain around his incision site and around his L AC [antecubital] (about 4 inches away from his PICC [Peripherally Inserted Central Catheter] line). He doesn't remember being at [Name of local hospital] recently and cannot tell but is able to talk about some specific details about his life.During an interview on 10/07/2025 at 1:36 PM, Staff A, Licensed Practical Nurse (LPN), stated, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 16 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some [Resident #1's name] had been transferred from another room during my shift [9/9/2025]. [Name of Staff B] had [Resident #1's name] prior to me and had called pharmacy who said they would be bringing his medication [vancomycin]. I called the pharmacy again and the pharmacy said they were enroute with the medication. I called the nurse practitioner; I believe her name is [APRN #1's name]. She [APRN #1] told me to extend the order for vancomycin for an extra day, so [Resident #1's name] would have the full course of the antibiotics. The pharmacy courier came in around 7:05 [PM] and brought me his medications. I passed them on to the night shift nurse because it was getting late. I don't think I wrote a note because I was in a rush to leave. I believe I should have documented the conversation with [name of APRN #1]. I don't know really if I can give the medication without a pump and I think that there is vancomycin in the [Name of the Automated Medication Dispensing Machine]. I don't think we can ask for a stat [derived from the Latin word statim, meaning immediately] delivery from the pharmacy.During an interview on 10/07/2025 at 1:38 PM, Staff B, LPN stated, [Resident #1's name] was an admission from the day before [9/8/2025]. The night-shift nurse [Staff E, LPN] told me that the nurse who admitted the resident did not put in [Resident #1's name] medication orders, so [Staff E's name] was not able to administer any medications for him. I can't remember if she called a provider, but I thought she had gotten an order to hold the vancomycin. If the medication was available in the [name of the automated medication dispensing machine] it should be administered. I know I should have notified the provider of the missed medications, and I should have documented the notification and any orders or instructions from the provider. I'm not sure if we can do a stat order from the pharmacy, we just regularly call the pharmacy and tell them we are waiting for the medication.During an interview on 10/07/2025 at 3:20 PM Staff E, LPN stated, Most of [Resident #1's name] medications were not available on the night shift of 9/8/25 - 9/9/25. The pharmacy doesn't come to the facility until 6:00 AM. Medication orders are typically entered to start the following day [after admission] because of the delivery times from the pharmacy, but [Resident #1's name] medications were ordered to start on the day of his admission [DATE]]. For the medications that were scheduled for my shift I was able to administer his cefepime because it was available in the [name of automated medication dispensing machine]. There was not a dose of vancomycin in the [name of automated medication dispensing machine] but there was overflow of vancomycin in the med [medication] room, as well as an overflow pump, so I was able to administer the ordered dose of vancomycin. I was not able to administer the morning dose of cefepime. I might have notified the doctor that I could not give the cefepime, but I am not sure. I did notify management that I did not give the cefepime, but I did not document the notification because I was already off of the [medication] cart. I know I should have written a note. Review of a form titled [Name of Pharmacy Provider] Transactions by Patient date 9/8/2025 documented vancomycin 1 gm one vial was removed at 7:50 PM, cefepime 1 gm two vials were removed, one at 7:49 PM and one at 7:53 PM. One bag of sodium chloride inj (injectable) 100 ml was removed at 7:55 PM from the [name of the automated medication dispensing machine] for [Resident #1's name]. Review of an email from Staff E, LPN addressed to Staff K, Previous Interim DON, dated 9/15/2025 at 4:41 PM read, On admission, resident [Resident #1] was ordered vancomycin and cefepime IV. Medications were not on hand but were available in [name of the automatic medication dispensing machine]. MAR reflected both medications scheduled for administration around 2100 [9:00 PM] on 9/8 [2025]. Cefepime was administered IV first, followed by vancomycin. Vancomycin infusion was prolonged due to patient's arm being constricted, which intermittently stopped the infusion. At 0600 [6:00 AM] on 9/9 [2025], MAR again showed scheduled doses for both vancomycin and cefepime. Unable to administer at that time because the vancomycin infusion from the previous evening was still running. Also, when the medications (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 17 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some were delivered from the pharmacy, only the vancomycin was supplied; cefepime was not included in the delivery. This information was passed on in report with recommendation that administration times for vancomycin and cefepime be adjusted accordingly. Additional interviews were attempted 10/8/2025 and 10/9/2025 with Staff E, LPN via telephone to provide clarification of the removal of 100 ml of sodium chloride and vancomycin 1 gram and two vials of cefepime and no additional sodium chloride removed from the automated medication dispensing machine for vancomycin and cefepime IV administration. The physician orders document vancomycin 1500 mg (1.5 grams) in 300 ml of sodium chloride and cefepime in 50 ml of sodium chloride. On the date of the exit, 10/10/2025, no return call was received. Review of the Ad Hoc (originally comes from Latin that means for this specific purpose, indicating the actions or solutions designed for a specific problem or situation) Quality Assurance & Performance Improvement Meeting dated 10/8/2025 documented, Data: Nurse removed 2 IV meds from [name of automatic medication dispensing machine], right med, wrong dose and administered. Root Cause Analysis: Nurse did not have medication that was due in her cart or med room and it had not been delivered from pharmacy. Medication removed from [name of automatic medication dispensing machine] right med but wrong dosage and dosage not verified before administration. During an interview on 10/7/2025 at 4:10 PM, Staff C, Pharmacy Account Manager stated, I am not familiar with the facility having any overflow medications or overstock of antibiotics, and the pharmacy does not leave extra IV pumps at the facility. For a resident admitted to the facility on a Monday at or around 5:00 PM, the medications would have been delivered the following morning. We do have a process for stat deliveries, and we would have routinely delivered within three and a half to four hours when ordered stat. During an interview on 10/07/2025 at 4:20 PM, Staff D, Lead Pharmacist stated, We make two deliveries to the facility daily. The deliveries leave the pharmacy at 2:00 PM and 2:00 AM, and then the deliveries arrive at the facility between 6:00 PM and 7:00 AM. I do not have knowledge of overflow or overstock medications. It was not part of the standard protocol for the pharmacy to supply any medications for general use outside of what was in the [name of the automated medication dispensing machine]. There are no extra IV pumps supplied to the facility. The facility can get a stat delivery from the pharmacy. For any medication ordered stat, we begin working on them as soon as we receive the order. The turnaround time for stat orders is four hours. If an IV pump was malfunctioning a replacement pump could be ordered stat. Vancomycin should be provided through an infusion pump to ensure proper administration and prevention of complications from administering to rapidly such as RMS [Red Man Syndrome, a type of allergic reaction that can occur with vancomycin administration] which typically could occur if vancomycin is infused too rapidly. We generally have orders to monitor vancomycin and manage the medication. Ideally in monitoring we are evaluating the Vanco [vancomycin] trough and adjusting doses from there, anything less than 10 is associated with higher levels of antibiotic resistance, ideally we attempt to maintain levels between 10-20 for optimal effect to maintain the drugs efficacy and minimize nephro [nephrotoxicity-damage to the kidneys] and ototoxicity toxicity [damage to hearing].During an interview on 10/8/2025 at 8:55 AM, APRN #1 [Advanced Practice Registered Nurse] stated, I saw [Resident #1's name] on 9/10/2025. I did not receive a call prior to my visit regarding the resident [Resident #1] or any issues with his antibiotics. I was asked by a facility nurse on 9/10/2025 if [Resident #1's name] vancomycin could be held because it was not available in the facility, but I believed the hold was not necessary as he was receiving his antibiotic infusion when I was in his room on 9/10/2025. I would give an order to hold antibiotics for one dose if the medications were on their way to the facility from the pharmacy. If it was more than one dose, I know what the resident was receiving in the hospital and that the medication was available in the facility. So, I would have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 18 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some given an order for that antibiotic to be given, or I would have determined if there was another medication available in the facility that I could order. I only recall speaking with a nurse regarding [Resident #1's name] on 9/10/2025 prior to seeing him. I do not recall speaking with anyone regarding a malfunctioning IV pump or giving orders to hold his vancomycin related to the issues with the IV pump. During an interview on 10/8/2025 at 9:25 AM, the Director of Nursing (DON) stated, When a resident is admitted the process is to get the orders in the computer so pharmacy can get them delivered. If the medications are not available, the nurses need to contact the physician. The nurses should contact the pharmacy and ask about getting medications from the [name of the automated medication dispensing machine] or ask for a stat delivery. There were also sister pharmacies they can contact for getting medications if there is a problem. We do have sister facilities they can call to get an IV pump. If medications are not in the facility for administration the nurses need to call the doctor and follow the physician's orders and document the process. The nurses should ask the doctor if there is an alternative medication they can give. The reasonable time frame for a nurse to wait on medications is an hour. If they were unable to administer an ordered antibiotic to a resident, the resident should be sent to the hospital. I have concerns regarding the competence of the facility nurses.During an interview on 10/08/2025 at 9:50 AM, the Medical Doctor stated, I do not recall being contacted regarding the resident [Resident #1] or any issues with his antibiotics. It was unfortunate that the resident did not receive his ordered antibiotics and of his readmission to the hospital. Residents have got to get the medications ordered for them. It is a shame that they were not administered, they should have been given. I'm aware that [missed doses of IV antibiotics] would cause concern for his admission for sepsis, not getting the medication may be a concern.During an interview on 10/08/2025 at 10:59 AM, APRN #2 stated, I got a message on 9/9/25 at 6:43 PM requesting that [Resident #1's name] vancomycin schedule be extended due to him missing a dose. I instructed the nurse to contact the pharmacy regarding the dosing of vancomycin. I was contacted only one time regarding only one missed dose of vancomycin. I would have only ordered the vanco to be held for one dose.During an interview on 10/08/2025 at 11:50 AM, Resident #1's mother stated, My son [Resident #1] is still in the hospital due to the bacteria he tested positive for when he was readmitted , and that he had to be on antibiotics for twelve hours out of every twenty-four. [Resident #1's name] had not received his vancomycin while he was in the facility, and I received conflicting information from the staff regarding the reason it was not being administered. [Resident #1's name] called me on 9/11/25 and told me that he did not know what was happening and he was confused. I was concerned about his altered mental status, and I called the Unit Manager in the facility to report my concerns. I was told that the nursing staff had not noticed any changes in his condition, but they would obtain labs. On 9/12/25 at around 2:00 PM [Resident #1's name] called me and told me he did not know where he was. I called the facility, reported my concerns and requested that he be transferred to the hospital.During an interview on 10/09/2025 at 8:05 AM, Staff G, LPN stated, I do not remember how many doses of vancomycin [Resident #1's name] had been scheduled during my shift on 9/10/2025. I was not able to administer the IV vancomycin because the IV pump was malfunctioning. I called the pharmacy and was told that the pharmacy had to receive the malfunctioning pump back before they would send a replacement IV pump. I spoke with the in-house nurse practitioner, [Name of APRN #1], who was in the building at that time. The nurse practitioner gave an order to hold the vanco, but I don't remember if the NP [nurse practitioner] said to hold the vanco for one dose or for one day. On 9/11[2025] there was a stat lab to check his vancomycin level. I had a conversation with a provider regarding the results of the vanco level and it would have been [APRN #1's name] I would have called. I can't remember if I told (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 19 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete [APRN #1's name] that the pump was still not there. I called the pharmacy again regarding the IV pump and was told the pump would be delivered that day. The pump arrived before the end of my shift on the day before he went to the hospital. During an interview on 10/10/2025 at 2:06 PM with the DON when asked regarding the significant medication errors related to the administration of vancomycin and cefepime for Resident #1 the DON stated, I am new to the facility. I wasn't here when this happened.2) Review of Resident #3's admission record documented the resident was admitted on [DATE] with diagnoses to include acute osteomyelitis, left ankle and foot, orthopedic aftercare following surgical amputation, type 2 diabetes, acquired absence of left leg below knee, acquired absence of other left toes, and unspecified sequelae of cerebral infraction.Review of Resident #3 physician order dated 10/3/2025 read, IVs: Flush Midline with 10cc of normal saline every shift and as needed. Review of Resident #3 MAR for the month of October 2025 for IV Flush 10cc documented on 10/4/2025 and 10/5/2025 at 12 :00 (midnight) administered by Staff H, LPN.Review of Resident #3's physician order dated 10/4/2025 read, Linezolid [antibiotic used to treat serious bacterial infections] intravenous solution 600 mg/300 ml (Linezolid) Use 300 ml intravenously every 12 hours for skin/skin infection for 5 days 150 ml/hr [milliliter per hour].Review of Resident #3's MAR for the month of October 2025 for Linezolid Intravenous Solution 300 ml documented on 10/04/2025 at 2100 [9:00 PM] administer by Staff H, LPN, and on 10/5/2025 at 2100 administered by Staff H, LPN.Review of Resident #3's physician orders dated 10/2/2025 read, Zosyn [intravenous antibiotic combination piperacillin and tazobactam; a broad-spectrum antibiotic used to treat moderate-to-severe bacterial infections] intravenous solution 3-0.375 gm/50 ml (3 grams of piperacillin and 0.375 grams of the beta-lactamase inhibitor tazobactam in De Event ID: Facility ID: 105460 If continuation sheet Page 20 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure physician-ordered parameters were followed related to hypertensive medications, resulting in the administration of unnecessary medications for 1 of 3 residents reviewed for medication administration (Resident #2).Findings include:Review of Resident #2's admission record documented diagnoses to include pneumonia, unspecified organism, chronic obstructive pulmonary disease with acute exacerbation (an increase in the severity of an illness), acute and chronic respiratory failure with hypercapnia (high carbon dioxide levels in the blood), low back pain unspecified, cognitive communication deficit, other malaise, muscle weakness generalized, orthopnea (shortness of breath that occurs when lying down), dehydration, dependence on supplemental oxygen, hyperlipidemia unspecified (high cholesterol), essential primary hypertension (high blood pressure), and hypercalcemia (high calcium levels in the blood).Review of Resident #2's physician order dated 4/25/2025 read, Metoprolol Tartare Oral Tablet 25 mg [milligram] (Metoprolol Tartare), give 0.5 tablet by mouth two times a day for HTN [hypertension]. Hold for SBP [Systolic Blood Pressure] < [less than] 110 or HR [heart rate] <70.Review of Resident #2's Medication Administration Record (MAR) for April 2025 documented Metoprolol was administered on 4/28/2025 at 0900 (9:00 AM) with a blood pressure (B/P) of 107/72, on 4/28/2025 at 2100 (9:00 PM) with a B/P of 101/68.Review of Resident #2's MAR for May 2025 documented Metoprolol was administered at 0900 on 5/12/2025 with a B/P of 102/77, on 5/16/2025 with a B/P of 109/58, on 5/24/2025 with a B/P of 101/64, on 5/30/2025 with a B/P of 100/57 and at 2100 on 5/8/2025 with a B/P of 98/62, on 5/13/2025 with a B/P of 106/67, on 5/22/2025 with a B/P of 98/64, and on 5/23/2025 with a B/P of 102/62.Review of Resident #2's MAR for June 2025 documented Metoprolol was administered at 0900 on 6/1/2025 with a B/P of 106/54, on 6/2/2025 with a B/P of 102/65, and on 6/16/2025 with a B/P of 96/52, and at 2100 on 6/5/2025 with a B/P of 98/63, on 6/14/2025 with a B/P of 107/82, and on 6/15/2025 with a B/P of 80/48.During an interview on 10/7/2025 at 1:00 PM, Staff A, Licensed Practical Nurse (LPN), stated, I'm not sure if I gave the medication, but I will usually put in that I held it, my initials mean it was given. We should follow orders and not administer medications outside parameters.During an interview on 10/7/2025 at 1:53 PM, Staff B, LPN, stated, I was not told that he [Resident #2] had any hypotension [low blood pressure] the night before. I would not have given his blood pressure medications. I would have held them. I can't remember if there were parameters for the medication.During an interview on 10/7/2025 at 3:10 PM, the Director of Nursing (DON) stated, I was not here during that time. I was not aware of any concerns related to his [Resident #2] care. All staff should administer medications as they are ordered and call the doctor or nurse practitioner if there is any change in vital signs.During a telephone interview on 10/7/2025 at 3:55 PM, Staff J, LPN, stated, I must have given it if I didn't document that I held the medicine. I don't really know, but if I documented I gave it I must have. We should follow the parameters if a medicine has them.During an interview on 10/8/2025 at 8:51 AM, the Advanced Practice Registered Nurse (APRN) #1 stated, I would not expect the staff to administer blood pressure medications outside the parameters.During a telephone interview on 10/8/2025 at 9:58 AM, the Medical Doctor (MD) stated, The staff should follow all orders with parameters and not administer them [medications] outside of those. I was not notified of this.During an interview on 10/8/2025 at 10:27 AM, Staff L, LPN, stated, I did give the medication [Metoprolol]. I'm not sure why I didn't hold it.Review of the policy and procedure titled Administering Medications with the last review date of 02/07/2025 read, Policy Statement: Medications are administered in a safe and timely manner, and as prescribed. Policy Interpretation and Implementation. 2. The Director of Nursing Services supervises and directs all personnel who administer medication and/or have related functions. 4. Medications are Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 21 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0757 administered in accordance with prescriber orders, including any required time frame. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 22 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure residents were free from significant medication errors when the facility failed to ensure residents were administered physician ordered antibiotics for 1 of 3 residents reviewed for intravenous (IV) antibiotic medication (Resident #1). The facility failure to ensure residents were free from significant medication errors when the residents were not administered the prescribed antibiotics per the physician order resulted in Immediate Jeopardy. Resident #1 was admitted on [DATE] with physician orders for Vancomycin 1500 mg IV every 8 hours intravenously for infection (osteomyelitis, an infection in the bone). On 9/8/2025 at approximately 10:00 PM, Resident #1 was administered one incorrect dose of Vancomycin 1000 mg. Resident #1 was not administered any further doses of Vancomycin 1500 mg until 9/12/2025 at 12:00 AM. Resident #1 missed 8 doses of Vancomycin between 9/9/2025 and 9/12/2025. On 9/11/2025, Resident #1 began to experience a change in condition of altered mental status, identified by a family member, who requested on 9/12/2025, that Resident #1 be sent to Emergency Department where he was diagnosed with sepsis [a life threatening emergency that damages the body's organs and can cause death]. Missing antibiotic doses can reduce the effectiveness of the treatment and increase the risk of antibiotic resistance, serious harm and/or death.The Administrator was notified of the Immediate Jeopardy on October 10, 2025, at 11:45 AM.Findings include: Review of Resident #1's admission record documented an admission date of 9/8/2025 with diagnoses to include subacute osteomyelitis [an infection in the bone], other site, spina bifida occulta [a small gap in one or more of the bones in the spine], other hydrocephalus [a buildup of fluid in the brain], paraplegia (an impairment in motor or sensory function of the lower extremities) unspecified, other bacterial infections of unspecified site, other seizures, local infection of the skin and subcutaneous tissue unspecified, iron deficiency, presence of cerebral spinal fluid drainage device, anemia unspecified, soft tissue disorder unspecified, unspecified visual loss, and gastroesophageal reflux disease [heartburn] without esophagitis [inflammation of the esophagus].Review of Resident's #1's Discharge summary dated [DATE] from [Name of local hospital] read, Outpatient IV ABX (antibiotic) orders: 1. Cefepime 1 g [gram] q8h [every 8 hours] or 3 g q24h [every twenty-four hours]. 2. Vancomycin 1500 mg [milligrams] q8h for 2 weeks.Review of Resident #1's physician order dated 9/8/2025 read, Vancomycin HCl [Hydrocholoride, a potent antibiotic used to treat severe bacterial infections, including those resistant to other antibiotics] intravenous solution 1500mg/300ml [1500 milligrams in 300 milliliters of sodium chloride] Use 1500 mg intravenously every 8 hours for Infection for 21 Days. Cefepime HCl [used to treat severe bacterial infections] intravenous solution 1 gm/50 ml (Cefepime HCl) Use 1 gram intravenously every 8 hours for infection for 21 days until finished.Review of Resident #1's MAR dated 9/8/205 documented Vancomycin HCl intravenous solution 1500 mg/300 ml (Vancomycin HCl) Use 1500 mg intravenously every 8 hours for infection for 21 days at 0600 (6:00 AM), 1400 (2:00 PM), and 2200 (10:00 PM).Review of a form titled [Name of Pharmacy Provider] Transactions by Patient, C14 [Form Code] date 9/8/2025 documented vancomycin 1 gm one vial was removed at 7:50 PM, cefepime 1 gm two vials were removed, one at 7:49 PM and one at 7:53 PM. One bag of sodium chloride inj (injectable) 100 ml bag was removed at 7:55 PM from the [name of the automated medication dispensing machine] for [Resident #1's name]. Additional interviews were attempted 10/8/2025 and 10/9/2025 with Staff E, LPN via telephone to provide clarification of the removal of 100 ml of sodium chloride and vancomycin 1 gram and two vials of cefepime and no additional sodium chloride removed from the automated medication dispensing machine for vancomycin and cefepime IV administration. The physician orders document vancomycin 1500 mg (1.5 grams) in 300 ml of sodium chloride and cefepime in 50 ml of sodium chloride. On Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 23 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few the date of the exit, 10/10/2025, no return call was received.Review of Resident #1's MAR dated 9/8/2025 documented vancomycin 1500 mg and cefepime 1 gram was administered IV at approximately 10:00 PM by the initialing of the MAR by Staff E, LPN.Review of the form titled [Name of pharmacy] Inventory on Hand dated 9/9/2025 documented vancomycin 1 gm [gram] vial on hand amount 4 vials were in the [name of the automated medication dispensing machine].Review of Resident #1's physician order dated 9/9/2025 read, Vancomycin intravenous solution 1500 mg [milligrams]/300 ml [milliliters] (Vancomycin HCl [hydrochloride] use 1500 mg intravenously every 8 hours for Infection for 21 Days. [Scheduled for 0000 (12:00 AM), 0800 (8:00 AM), and 1600 (4:00 PM).Review of Resident #1's Medication Administration Record for the month of September 2025 for vancomycin 1500 mg intravenously was documented as chart code 9 (other see nurses notes) on 9/9/2025 at 0800 (8:00 AM) and 1600 (4:00 PM), on 9/10/2025 there is an X [not given] at 12:00 midnight and a chart code of 9 at 0800 [8:00 AM] and 1600. On 9/11/2025 a chart code of H [hold] at 1200 [12:00 AM], 0800, and 1600 for a total of 8 missed doses of vancomycin.Review of Resident #1's physician order dated 9/8/25 read, Cefepime HCl intravenous solution 1 gm/50 ml. (Cefepime HCl: Use 1 gram intravenously every 8 hours for Infection for 21 Days until finished. [Scheduled for 6:00 AM, 1400 (2:00 PM), and 2200 (10:00 PM)]Review of Resident #1's MAR dated 9/9/2025 at 6:00 AM for Cefepime HCl Intravenous documented a chart code of 5 (Hold/See Nurse Notes) at 0600 (6:00 AM) and a chart code 9 at 1400. For a total of two missed doses.Review of Resident #1's MAR dated 09/10/2025 at 6:00 AM, 2:00 PM, and 10:00 PM documented cefepime was administered. Vancomycin for the date of 9/10/2025 documented at 12:00 midnight X (not administered), at 8:00 AM and 4:00 PM code 9 (Other/see Nurse Notes).Review of Resident #1's progress note dated 9/9/2025 at 7:32 AM for Vancomycin 1500 mg IV read, Order needs to be updated.Review of Resident #1's progress note dated 9/9/2025 at 4:21 PM for Vancomycin 1500 mg IV read, Will be in on evening run per pharmacy.Review of Resident #1's progress note dated 9/10/2025 at 12:28 PM read, Vancomycin HCl intravenous solution 1500 mg/300 ml use 1500 mg intravenously every 8 hours for infection for 21 days. The pharmacy sent a malfunctioning pump, and the writer reached out to inform them of the issue. The pharmacy stated that the problem would be addressed during the next run. The NP [nurse practitioner] was notified and confirmed it was okay to put the medication on hold until then.Review of Resident #1's physician progress note dated 9/10/2025 at 13:23 (1:23 PM) authored by APRN #1 (Advanced Practitioner Registered Nurse) read, He has now been admitted to the skilled nursing facility for continuation of IV vancomycin and cefepime, wound care management, and rehabilitation support. Assessment/Plan: Chronic osteomyelitis, unspecified site with recent surgical intervention. Active, high-risk condition. Patient with recurrent osteomyelitis, currently on IV vancomycin and cefepime per infectious disease recommendations. Plan: Continue IV vancomycin and cefepime per protocol. Monitor temperature, WBC [white blood cell] trends, renal function, and vancomycin trough levels. Maintain coordination with infectious disease and wound care teams.Review of Resident #1's eInteract SBAR (Situation, Background, Assessment, Recommendation) dated 9/11/2025 at 3:33 PM read, Situation: The Change In Condition/s reported on this CIC Evaluation are/were: Altered mental status. Outcomes of Physical Assessment: Positive findings reported on the resident/patient evaluation for this change in condition were: Mental Status Evaluation: Altered level of consciousness. Neurological Status Evaluation: Altered level of consciousness. Primary Care Provider Feedback: Primary Care Provider responded with the following feedback: A. Recommendations: cbc [complete blood count], cmp [complete metabolic profile] vanco [vancomycin] trough [a blood test used for monitoring the vancomycin medication administration]. Review of Resident #1's physician order dated 9/11/2025 read, CBC w/ Diff [differential], comprehensive panel/vancomycin pre-dose (trough) one time only related to presence of cerebrospinal fluid (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 24 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few drainage device, iron deficiency, other seizures, local infection of the skin and subcutaneous tissue, unspecified anemia, unspecified, other hydrocephalus, subacute osteomyelitis, other site, soft tissue disorder, unspecified, other bacterial infections of unspecified site, spina bifida occulta. Review Resident #1's Laboratory result report with a specimen collection date of 9/11/2025 and report date of 9/12/2025 read, Vancomycin trough final result <2.0 [less than] ug (micrograms)/ml (milliliter) (L) (low) - Ref. [reference] Range Units: 5.0 - 20.0 ug.Review of Resident #1's eInteract Transfer Form dated 9/12/2025 at 10:16 AM read, Section A: Demographic and Transfer information: 2. Transfer/discharge details. Send to [Name of local hospital], sent from [Name of Nursing home]. Reason(s) for transfer: other; Other reason for transfer: possible sepsis.Review of Resident #1's Interactive SBAR dated 9/12/2025 at 10:28 AM read, Situation: The Change In Condition (CIC)/s reported on this CIC Evaluation are/were: Other change in condition. Primary Care Provider Feedback: Primary Care Provider responded with the following feedback: A. Recommendations: send out for further evaluation.Review of Resident #1's medical record from [Name of Hospital] titled ‘ED [Emergency Department] to Hosp [Hospital]- admission (Current) dated 9/12/2025 read, ED course & re-evaluation: [Resident #1's name], a [AGE] year-old male with a PMHx [past medical history] of spina bifida occulta with hydrocephalus [a buildup of fluid in the brain] s/p [status post] [NAME] rod [a stainless steel surgical device used to treat a curvature of the spine] and VP [ventriculoperitoneal] shunt [a tube in the brain to drain fluid into the stomach], paraplegia, paralysis (the loss of the ability to move certain parts of the body typically as a result of illness or injury) below T8 [thoracic nerve number 8] + chronically wheelchair bound and chronic sacral wound, who presents today from outside skilled facility with AMS [altered mental status], tachycardia [a high heart rate], and concerns for sepsis [a life threatening emergency that damages the body's organs and can cause death] w [with]/new onset of leukocytosis [an abnormally high number of white blood cells (leukocytes) in the bloodstream] of 15 [indicates the body is fighting an infection]. On arrival, he was tachycardic [related to a high heart rate] but hemodynamically stable [a state in which the cardiovascular system is functioning properly and maintaining adequate blood flow throughout the body]. He was sepsis alerted given concern for infection and initial tachycardia with leukocytosis at outside facility. He was started on Vancomycin, cefepime and 30 cc [cubic centimeters]/kg [kilogram] IVF [intravenous fluids] with source concerning for recurrent osteomyelitis [an infection of the bone] and possible abscess [a pocket of pus] at recent surgical site in the setting of subtherapeutic [low level that is too low to produce the intended medical effect] Vancomycin + [plus] missing antibiotic dose. Regarding his AMS [altered mental status], his mother noted repetitive questioning and confusion otherwise no new neurologic deficits. His VP shunt is compressible. Will further evaluate additional causes of AMS with labs and imaging. Anticipate admission. ED [Emergency Department] Clinical Impression: Osteomyelitis of left femur, unspecified type, septic hip s/p [NAME] procedure, abscess of hip, left, sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present, acute encephalopathy [a disturbance in brain function that causes confusion and memory loss].Review of Resident #1 [Name of Hospital] medical record titled History and Physical dated 9/12/2025 read, [Resident #1's name] is a 39 y.o. [year old] male with medical history significant for spina bifida occulta with hydrocephalus s/p VP shunt and [NAME] spinal rod placement, paraplegia and chronically wheelchair bound admitted for altered mental status secondary to sepsis from acute on chronic osteomyelitis of the left hip. The patient was recently hospitalized from 8/11-9/8/2025 for sepsis secondary to acute on chronic osteomyelitis and underwent a [NAME] procedure. He was then discharged to SNF [skilled nursing facility] for rehabilitation and continued IV antibiotic course for treatment of his acute infection. He has now been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 25 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few brought back to the ED due to altered mental status. He is currently accompanied by his mother who is at bedside. She states that the patient has been at the facility for several days since being discharged with IV antibiotics, however she has been concerned as she does not believe he has been receiving these medications or at least on a reliable schedule. She states that he began to act abnormal yesterday at which time he had completely forgotten the fact that he had just been hospitalized for two weeks. Today is alert and oriented only to self. He struggles with location, year, and current president. On arrival to the ED, the patient was found to be afebrile [not having a fever] with vitals remarkable for sinus tachycardia. Labs are remarkable for leukocytosis (WBC 15) and elevated CRP [C-Reactive Protein, indicative of inflammation in the body] (21.14). CT [Computed Tomography] imaging has revealed acute on chronic osteomyelitis of the left hip with details concerning for septic joint formation. There is also noted to likely be subperiosteal abscess (infection to the tissue located the surface of the bones) formation along the medical margin of the femoral head with a communicating sinus tract to the posterior medial skin of the left proximal thigh. Assessment and plan: [Resident #1's name] is a 39 y.o. male who is admitted for altered mental status secondary to sepsis from acute on chronic osteomyelitis of the left hip. Active Problems: #Sepsis, reason for admission, #Acute on Chronic Osteomyelitis, #Altered Mental Status, resolved - admitted for sepsis secondary to acute on chronic osteomyelitis that has likely worsened secondary to poor wound care lack of proper antibiotic usage.Review of Resident #1 [Name of Local Hospital] Infectious Disease note dated 9/13/2025 read, [Resident #1's name] is a 39 y.o. male with above mentioned PMHx admitted on [DATE] with chief complaint of altered mental status 1 day prior to admission. Recently admitted 8/11-9/8 for acute on chronic osteomyelitis of L [left] ischium, was planned for Flagyl (8/19-9/1), Vancomycin (8/19-9/29), and Cefepime (8/19-9/29). Underwent debridement during this time (see above). Unfortunately, the patient may not have received his antibiotics in an appropriate manner and may be contributory to the patient's current presentation. He currently complains of a 1/2 [one out of two] pain around his incision site and around his L AC [antecubital] (about 4 inches away from his PICC [Peripherally Inserted Central Catheter] line). He doesn't remember being at [Name of local hospital] recently and cannot tell but is able to talk about some specific details about his life.Review of an email from Staff E, LPN addressed to Staff K, Previous Interim DON, dated 9/15/2025 at 4:41 PM read, On admission, resident [Resident #1] was ordered vancomycin and cefepime IV. Medications were not on hand but were available in [name of the automatic medication dispensing machine]. MAR reflected both medications scheduled for administration around 2100 [9:00 PM] on 9/8 [2025]. Cefepime was administered IV first, followed by vancomycin. Vancomycin infusion was prolonged due to patient's arm being constricted, which intermittently stopped the infusion. At 0600 [6:00 AM] on 9/9 [2025], MAR again showed scheduled doses for both vancomycin and cefepime. Unable to administer at that time because the vancomycin infusion from the previous evening was still running. Also, when the medications were delivered from the pharmacy, only the vancomycin was supplied; cefepime was not included in the delivery. This information was passed on in report with recommendation that administration times for vancomycin and cefepime be adjusted accordingly.During an interview on 10/07/2025 at 1:36 PM, Staff A, Licensed Practical Nurse (LPN), stated, [Resident #1's name] had been transferred from another room during my shift [9/9/2025]. [Name of Staff B] had [Resident #1's name] prior to me and had called pharmacy who said they would be bringing his medication [vancomycin]. I called the pharmacy again and the pharmacy said they were enroute with the medication. I called the nurse practitioner; I believe her name is [APRN #1's name]. She [APRN #1] told me to extend the order for vancomycin for an extra day, so [Resident #1's name] would have the full course of the antibiotics. The pharmacy courier came in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 26 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few around 7:05 [PM] and brought me his medications. I passed them on to the night shift nurse because it was getting late. I don't think I wrote a note because I was in a rush to leave. I believe I should have documented the conversation with [name of APRN #1]. I don't know really if I can give the medication without a pump and I think that there is vancomycin in the [name of the automated medication dispensing machine]. I don't think we can ask for a stat [derived from the Latin word statim, meaning immediately] delivery from the pharmacy.During an interview on 10/07/2025 at 1:38 PM, Staff B, LPN stated, [Resident #1's name] was an admission from the day before [9/8/2025]. The night-shift nurse [Staff E, LPN] told me that the nurse who admitted the resident did not put in [Resident #1's name] medication orders, so [Staff E's name] was not able to administer any medications for him. I can't remember if she called a provider, but I thought she had gotten an order to hold the vancomycin. If the medication was available in the [name of the automated medication dispensing machine] it should be administered. I know I should have notified the provider of the missed medications, and I should have documented the notification and any orders or instructions from the provider. I'm not sure if we can do a stat order from the pharmacy, we just regularly call the pharmacy and tell them we are waiting for the medication.During an interview on 10/07/2025 at 3:20 PM Staff E, LPN stated, Most of [Resident #1's name] medications were not available on the night shift of 9/8/25 - 9/9/25. The pharmacy doesn't come to the facility until 6:00 AM. Medication orders are typically entered to start the following day [after admission] because of the delivery times from the pharmacy, but [Resident #1's name] medications were ordered to start on the day of his admission [DATE]]. For the medications that were scheduled for my shift I was able to administer his cefepime because it was available in the [name of automated medication dispensing machine]. There was not a dose of vancomycin in the [name of automated medication dispensing machine] but there was overflow of vancomycin in the med [medication] room, as well as an overflow pump, so I was able to administer the ordered dose of vancomycin. I was not able to administer the morning dose of cefepime. I might have notified the doctor that I could not give the cefepime, but I am not sure. I did notify management that I did not give the cefepime, but I did not document the notification because I was already off of the [medication] cart. I know I should have written a note. During an interview on 10/7/2025 at 4:10 PM, Staff C, Pharmacy Account Manager stated, I am not familiar with the facility having any overflow medications or overstock of antibiotics, and the pharmacy does not leave extra IV pumps at the facility. For a resident admitted to the facility on a Monday at or around 5:00 PM, the medications would have been delivered the following morning. We do have a process for stat deliveries, and we would have routinely delivered within three and a half to four hours when ordered stat. During an interview on 10/07/2025 at 4:20 PM, Staff D, Lead Pharmacist stated, We make two deliveries to the facility daily. The deliveries leave the pharmacy at 2:00 PM and 2:00 AM, and then the deliveries arrive at the facility between 6:00 PM and 7:00 AM. I do not have knowledge of overflow or overstock medications. It was not part of the standard protocol for the pharmacy to supply any medications for general use outside of what was in the [name of the automated medication dispensing machine]. There are no extra IV pumps supplied to the facility. The facility can get a stat delivery from the pharmacy. For any medication ordered stat, we begin working on them as soon as we receive the order. The turnaround time for stat orders is four hours. If an IV pump was malfunctioning a replacement pump could be ordered stat. Vancomycin should be provided through an infusion pump to ensure proper administration and prevention of complications from administering to rapidly such as RMS [Red Man Syndrome, a type of allergic reaction that can occur with vancomycin administration] which typically could occur if vancomycin is infused too rapidly. We generally have orders to monitor vancomycin and manage the medication. Ideally in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 27 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few monitoring we are evaluating the Vanco [vancomycin] trough and adjusting doses from there, anything less than 10 is associated with higher levels of antibiotic resistance, ideally we attempt to maintain levels between 10-20 for optimal effect to maintain the drugs efficacy and minimize nephro [nephrotoxicity-damage to the kidneys] and ototoxicity toxicity [damage to hearing].During an interview on 10/8/2025 at 8:55 AM, APRN #1 [Advanced Practice Registered Nurse] stated, I saw [Resident #1's name] on 9/10/2025. I did not receive a call prior to my visit regarding the resident [Resident #1] or any issues with his antibiotics. I was asked by a facility nurse on 9/10/2025 if [Resident #1's name] vancomycin could be held because it was not available in the facility, but I believed the hold was not necessary as he was receiving his antibiotic infusion when I was in his room on 9/10/2025. I would give an order to hold antibiotics for one dose if the medications were on their way to the facility from the pharmacy. If it was more than one dose, I know what the resident was receiving in the hospital and that the medication was available in the facility. So, I would have given an order for that antibiotic to be given, or I would have determined if there was another medication available in the facility that I could order. I only recall speaking with a nurse regarding [Resident #1's name] on 9/10/2025 prior to seeing him. I do not recall speaking with anyone regarding a malfunctioning IV pump or giving orders to hold his vancomycin related to the issues with the IV pump. During an interview on 10/8/2025 at 9:25 AM, the Director of Nursing (DON) stated, When a resident is admitted the process is to get the orders in the computer so pharmacy can get them delivered. If the medications are not available, the nurses need to contact the physician. The nurses should contact the pharmacy and ask about getting medications from the [name of the automated medication dispensing machine] or ask for a stat delivery. There were also sister pharmacies they can contact for getting medications if there is a problem. We do have sister facilities they can call to get an IV pump. If medications are not in the facility for administration the nurses need to call the doctor and follow the physician's orders and document the process. The nurses should ask the doctor if there is an alternative medication they can give. The reasonable time frame for a nurse to wait on medications is an hour. If they were unable to administer an ordered antibiotic to a resident, the resident should be sent to the hospital. I have concerns regarding the competence of the facility nurses.During an interview on 10/08/2025 at 9:50 AM, the Medical Doctor stated, I do not recall being contacted regarding the resident [Resident #1] or any issues with his antibiotics. It was unfortunate that the resident did not receive his ordered antibiotics and of his readmission to the hospital. Residents have got to get the medications ordered for them. It is a shame that they were not administered, they should have been given. I'm aware that [missed doses of IV antibiotics] would cause concern for his admission for sepsis, not getting the medication may be a concern.During an interview on 10/08/2025 at 10:59 AM, APRN #2 stated, I got a message on 9/9/25 at 6:43 PM requesting that [Resident #1's name] vancomycin schedule be extended due to him missing a dose. I instructed the nurse to contact the pharmacy regarding the dosing of vancomycin. I was contacted only one time regarding only one missed dose of vancomycin. I would have only ordered the vanco to be held for one dose.During an interview on 10/08/2025 at 11:50 AM, Resident #1's mother stated, My son [Resident #1] is still in the hospital due to the bacteria he tested positive for when he was readmitted , and that he had to be on antibiotics for twelve hours out of every twenty-four. [Resident #1's name] had not received his vancomycin while he was in the facility, and I received conflicting information from the staff regarding the reason it was not being administered.During an interview on 10/09/2025 at 8:05 AM, Staff G, LPN stated, I do not remember how many doses of vancomycin [Resident #1's name] had been scheduled during my shift on 9/10/2025. I was not able to administer the IV vancomycin because the IV pump was malfunctioning. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 28 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few I called the pharmacy and was told that the pharmacy had to receive the malfunctioning pump back before they would send a replacement IV pump. I spoke with the in-house nurse practitioner, [Name of APRN #1], who was in the building at that time. The nurse practitioner gave an order to hold the vanco, but I don't remember if the NP [nurse practitioner] said to hold the vanco for one dose or for one day. On 9/11[2025] there was a state lab to check his vancomycin level. I had a conversation with a provider regarding the results of the vanco level and it would have been [APRN #1's name] I would have called. I can't remember if I told [APRN #1's name] that the pump was still not there. I called the pharmacy again regarding the IV pump and was told the pump would be delivered that day. The pump arrived before the end of my shift on the day before he went to the hospital. During an interview on 10/10/2025 at 2:06 PM with the DON when asked regarding the significant medication errors related to the administration of vancomycin and cefepime for Resident #1 the DON stated, I am new to the facility. I wasn't here when this happened.Review of the facility policy and procedure titled Medication Shortages/Unavailable Medications, with a last review date of 02/07/2025 read, Policy: When medications are not received or are unavailable for the customers, the licensed nurse will urgently initiate action in cooperation with the attending physician and the pharmacy provider. Procedure: A. If the medication shortage is noted at the time of the medication administration (Med-Pass), the licensed nurse or certified medication assistant must immediately initiate action to obtain the medication and not wait until the med pass is completed. B. If a medication shortage is noted during normal pharmacy hours: 1. A licensed nurse notifies the pharmacy and speaks to a registered pharmacist to determine the status of the order. Facility link may also be utilized to order or reorder medications and or determine the status of a new or reordered medication, if not ordered, place the order or reorder to be sent with the next scheduled delivery. 2. If the next available delivery results in a delay or missed dose in the customers medication schedule, not available in the emergency stock, notify the pharmacist that an emergency delivery is required. 3. If medication from emergency stock is utilized ensure that the pharmacy received the faxed information (i.e., customer name, drug, dose) for replacement and appropriate billing. C. If a medication shortage is noted after normal pharmacy hours: 1. A licensed nurse obtains the ordered medication from the emergency stock supply. 2. If the ordered medication is unavailable in the emergency stock supply, a licensed nurse calls the pharmacy's emergency answering service and request to speak with a registered pharmacist on call to determine the plan of action which may include: a. Emergency/Stat delivery. B. Use of emergency (backup) pharmacy. D. If an emergency delivery is not feasible, a licensed nurse contacts the attending physician to obtain orders or directions which may include: 1. Holding the dose/doses. 2. Use of alternative medication available from the emergency stock supply. 3. Change in order (time of administration or medication). F. When a missed dose is unavoidable: 1. Document missed dose on the medication administration record (MAR) or treatment administration record (TAR): a. Initial and circle to indicate any missed dose document explanation for missed dose according to physician's order: e.g. hold dose on back of MAR/TAR and indicate See nurses note for explanation. 2. Document explanation of missed dose in the nurses' notes: a. Describe circumstances of medication shortage. B. Notification of pharmacy and response.Review of the facility policy and procedure titled Administering Medications with a last review date of 02/07/2025 read, Policy Statement: Medications are administered in a safe and timely manner, and as prescribed. Policy Interpretation and Implementation. 2. The Director of Nursing Services supervises and directs all personnel who administer medication and/or have related functions. 4. Medications are administered in accordance with prescriber orders, including any required time frame. 5. Medication administration times are determined by resident need and benefit, not staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 29 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete convenience. Factors that are considered include: a. Enhancing optimal therapeutic effect of the medication. 6. Medication errors are documented, reported, and reviewed by the QAPI committee to inform process changes and or the need for additional staff training.Review of the policy and procedure titled, 1.0 Providing Pharmacy Services, with the last review date of 02/07/2025 read, Policy: [Name of Pharmacy Provider] will: Provide a continuum of pharmaceutical services to the facility and essential medication and services for the customers. Ensure that the facility staff has access to medications, emergency service for medications, and drug information on a twenty-four (24) hour basis. Procedure: A. [Name of Pharmacy Provider] provides the facility with details how the customer can contact [Name of Pharmacy Provider] twenty-four (24) hours a day, seven (7) days a week. D. If orders for medication are received from the physician the facility may: 1. A delay in medication therapy can be prevented by using a drug that is included in the facility's Back-up Box/stat/emergency kit drug supply [located in the [name of the automated medication dispensing machine]. 3. If a drug is considered essential and cannot be substituted or delayed, please contact the [Name of Pharmacy Provider] Emergency Number. Event ID: Facility ID: 105460 If continuation sheet Page 30 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure complete and accurate documentation of medical records for 3 of 4 residents reviewed for intravenous therapy documentation (Residents #1, #2, and #3).Findings include:1. Review of Resident #2's admission record documented diagnoses that include pneumonia, unspecified organism, chronic obstructive pulmonary disease with acute exacerbation (an increase in the severity of an illness), acute and chronic respiratory failure with hypercapnia (high carbon dioxide levels in the blood), low back pain unspecified, cognitive communication deficit, other malaise, muscle weakness generalized, orthopnea (shortness of breath that occurs when lying down), dehydration, dependence on supplemental oxygen, hyperlipidemia unspecified (high cholesterol), essential primary hypertension (high blood pressure), and hypercalcemia (high calcium levels in the blood).Review of Resident #2's physician order dated 6/13/2025 read, Please insert PIV [Peripheral Intravenous] for dehydration. One time only for IV [intravenous] access for 1 Day.Review of Resident #2's nursing progress notes from 6/12/2025 through 6/16/2025 showed no documentation of peripheral intravenous line insertion.During an interview on 10/7/2025 at 3:10 PM, the Director of Nursing (DON) stated, I was not aware of any concerns related to his [Resident #2] care. There should be documentation of all care provided. I do not see any documentation about the IV insertion and there should be. They [the nursing staff] should document where the IV is, how many times it took to get a line, if they were successful or not, and what fluids were running and if the site was okay.During an interview on 10/7/2025 at 1:53 PM, Staff B, Licensed Practical Nurse (LPN), stated, It was close to end of day, his [Resident #2's] [representative] had questions that I could not answer. Why were fluids hanging? It was a full bag [of IV fluids] that was hanging and why had an IV been placed, because there were no orders. I didn't see any orders for IV fluids or the IV when I was talking to her. But once the order is complete, they will fall off the MAR [Medication Administration Record], so I needed to look at them. I did not flush or do anything that day with his IV.2. Review of Resident #3's admission record documented an admission date of 9/25/2025 with diagnose to include other acute osteomyelitis (an infection of the bone) left ankle and foot, type 2 diabetes mellitus with unspecified complications, acquired absence of left leg below knee, depression unspecified, and unspecified sequela of cerebral infarction (a stroke).Review of Resident #3's record titled Admission/Readmission read, Section H: Vascular Access: 1. IV present: 2: checked yes. 2. Type:1. Peripheral checked. 3. Location: arm right.Review of Resident #3's physician order dated 9/26/2025 read, May remove peripheral IV. One time only for 1 day.Review of Resident #3's nursing progress notes from 9/25/2025 through 10/2/2025 showed no notes related to the removal of the peripheral IV.3. Review of Resident #1's admission record documented an admission date of 9/8/2025 with diagnoses to include subacute osteomyelitis [an infection in the bone], other site, spina bifida occulta [a small gap in one or more of the bones in the spine], other hydrocephalus [a buildup of fluid in the brain], paraplegia (an impairment in motor or sensory function of the lower extremities) unspecified, other bacterial infections of unspecified site, other seizures, local infection of the skin and subcutaneous tissue unspecified, iron deficiency, presence of cerebral spinal fluid drainage device, anemia unspecified, soft tissue disorder unspecified, unspecified visual loss, and gastroesophageal reflux disease [heartburn] without esophagitis [inflammation of the esophagus].Review of Resident #1's physician order dated 9/8/2025 read, Vancomycin HCl [Hydrocholoride, a potent antibiotic used to treat severe bacterial infections, including those resistant to other antibiotics] intravenous solution 1500mg/300ml [1500 milligrams in 300 milliliters of sodium chloride] Use 1500 mg (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 31 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few intravenously every 8 hours for Infection for 21 Days.Review of Resident #1's physician order dated 9/8/2025 read, Cefepime HCI (antibiotic used to treat a wide variety of serious bacterial infections) intravenous solution 1 gm/50 ml [1 gram per 50 milliliter] (Cefepime HCI (hydrochloride)) Use 1 gram intravenously every 8 hours for infection for 21 Days until finished. Review of Resident #1's Medication Administration Record for the month of September 2025 for vancomycin 1500 mg intravenously was documented as chart code 9 (other see nurses notes) on 9/9/2025 at 0800 (8:00 AM) and 1600 (4:00 PM), on 9/10/2025 there is an X [not given] at 12:00 midnight and a chart code of 9 at 0800 [8:00 AM] and 1600 (4:00 PM). On 9/11/2025 a chart code of H [hold] at 1200 [12:00 AM], 0800, and 1600 for a total of 8 missed doses of vancomycin.Review of Resident #1's MAR for cefepime dated 09/9/2025 at 6:00 AM documented a code of 5 (Hold/see Nurses Notes) and 1400 (2:00 PM) a code of 9 (Other/See Nurses Notes). For a total of two missed doses.During an interview on 10/07/2025 at 1:36 PM, Staff A, Licensed Practical Nurse (LPN), stated, [Resident #1's name] had been transferred from another room during my shift [9/9/2025]. [Name of Staff B] had [Resident #1's name] prior to me and had called pharmacy who said they would be bringing his medication [vancomycin]. I called the pharmacy again and the pharmacy said they were enroute with the medication. I called the nurse practitioner; I believe her name is [APRN #1's name]. She [APRN #1] told me to extend the order for vancomycin for an extra day, so [Resident #1's name] would have the full course of the antibiotics. The pharmacy courier came in around 7:05 [PM] and brought me his medications. I passed them on to the night shift nurse because it was getting late. I don't think I wrote a note because I was in a rush to leave. I believe I should have documented the conversation with [name of APRN #1].During an interview on 10/07/2025 at 1:38 PM, Staff B, LPN stated, [Resident #1's name] was an admission from the day before [9/8/2025]. The night-shift nurse [Staff E, LPN] told me that the nurse who admitted the resident did not put in [Resident #1's name] medication orders, so [Staff E's name] was not able to administer any medications for him. I can't remember if she called a provider, but I thought she had gotten an order to hold the vancomycin. If the medication was available in the [name of the automated medication dispensing machine] it should be administered. I know I should have notified the provider of the missed medications, and I should have documented the notification and any orders or instructions from the provider. I'm not sure if we can do a stat order from the pharmacy, we just regularly call the pharmacy and tell them we are waiting for the medication.During an interview on 10/07/2025 at 3:20 PM Staff E, LPN stated, Most of [Resident #1's name] medications were not available on the night shift of 9/8/25 - 9/9/25. The pharmacy doesn't come to the facility until 6:00 AM. Medication orders are typically entered to start the following day [after admission] because of the delivery times from the pharmacy, but [Resident #1's name] medications were ordered to start on the day of his admission [DATE]]. For the medications that were scheduled for my shift I was able to administer his cefepime because it was available in the [name of automated medication dispensing machine]. There was not a dose of vancomycin in the [name of automated medication dispensing machine] but there was overflow of vancomycin in the med [medication] room, as well as an overflow pump, so I was able to administer the ordered dose of vancomycin. I was not able to administer the morning dose of cefepime. I might have notified the doctor that I could not give the cefepime, but I am not sure. I did notify management that I did not give the cefepime, but I did not document the notification because I was already off of the [medication] cart. I know I should have written a note. Review of the policy and procedure titled Catheter Insertion and Care with an effective date of 1/17/2019 and the last approval date of 2/7/2025 read, Documentation: The following information should be recorded in the resident's medical record: 1. The date and time of the procedure. 2. The number of venipuncture attempts (maximum of two). 3. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 32 of 33 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 105460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at North Florida 6700 NW 10th Place Gainesville, FL 32605 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 0842 Level of Harm - Minimal harm or potential for actual harm The type, length and gauge of the catheter, and type of cleansing agent used. 4. The site of insertion (be specific to name of vein, area of arm). 5. The type of solution used or medication infusing (if being used at this time). 10. Resident's response to the procedure. 11. The signature and title of the person recording the data. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105460 If continuation sheet Page 33 of 33