Health inspection·April 8, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to ensure the resident's environment remained as free of accident hazards as possible for one (Resident #2) of three residents reviewed for accident hazards. A bottle of Zyrtec (over the counter allergy medication) and [NAME] nasal spray were found on Resident #2's bedside table. Resident's son brought over-the-counter medications to the resident on 4/7/25 at approximately 1:00 pm, and facility staff did not remove the medication until after 9:45 am on 4/8/25. During this time, approximately 21 hours and three shifts later, other residents had access to the medication at Resident #2's bedside. The findings include: On 4/8/25 at 9:41 am, Resident #2's room was observed. A bottle of Zyrtec and [NAME] nasal spray were observed sitting on top of the bedside table. (Photographic evidence obtained) When the resident was asked how she got the medications. She stated, My son brought them to me around 1 pm yesterday, I know that I'm not supposed to have them. I'll probably just put them away or give them to my son when he comes. When asked if she had spoken to anyone in the facility about getting orders for these medications. She stated, They have nasal spray, but I used this brand at home, so I asked my son to bring it for me. I'll let him take it home with him when he comes, he visits every day at 1:00 pm and he takes me outside for fresh air. A review of Resident #2's medical record revealed she had a BIMS (brief interview for mental status) score of 15/15, indicating intact cognition. The record review revealed no physician orders for [NAME] nasal spray. No physician orders to self-medicate was found in the record. No assessment for self-administration of medications was found in the record. A review of Resident #2 care plan revealed she was not care planned for self-administration of medications. On 4/8/25 at 2:38 pm, an interview was conducted with Employee A LPN (Licensed Practical Nurse). She was asked about the facility's process for residents who self-administer medication. She stated, Well first it has to be approved by the doctor and then the resident must be assessed by the nurse to determine if they are able to self-medicate. Then some patient teaching is done and then we get an order to self-medicate. It is also added to the care plan. She was asked to explain the facility process for observing unauthorized medications at the resident's bedside. We confiscate it, educate the resident and family members to why they shouldn't have it. If the resident insists on self-medicating we can assess if they can self-medicate, if not we explain why they can't. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 105617 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 105617 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante Villa at Jacksonville Beach Inc 1504 Seabreeze Ave Jacksonville Beach, FL 32250 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)