Health inspection·November 17, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete nurse's discretion to refuse or not provide a resident without their scheduled pain medications. Staff B, UM said that medication was not administered as scheduled for Hydrocodone on 11/14/25 and 11/15/25.On 11/17/25 at 3:25 PM an interview with the Interim Director of Nursing (DON) and the Assistant Director of Nursing (ADON) in training was conducted. The DON stated staff should re-attempt to wake up the resident to administer scheduled pain medications with no specific time frame and also make a note in the resident's progress notes of the attempts. The DON confirmed there was no medication administered to the resident both dates of 11/14/25 and 11/15/25. The DON stated for both missed doses should have been administered to Resident #3 since they were scheduled. The DON said the expectation was for nurses to attempt to wake up the resident. The DON said it was not up to the nurses' discretion on when to and when not to administer medications. A review of the facility's Pain Management Guidelines revealed the following: The facility staff will identify key characteristics of the pain which includes: . iv. Timing. Based upon the evaluation, the facility in collaboration with the attending physician/prescriber, other health care professionals and the resident and/or the residents representative will develop, implement, monitor and revise as necessary interventions to prevent or manage each individual resident's pain beginning at admission. Event ID: Facility ID: 105688 If continuation sheet Page 2 of 4 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 105688 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at the Bay 10300 4th St N Saint Petersburg, FL 33716 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews and record review, the facility did not ensure to advise physicians or family representatives of missed scheduled pain medications for one resident (#3) out of three residents reviewed and sampled. Findings included: Findings included: On 11/17/25 at 10:37 AM, Resident #3 reported waking up in the middle of the night in pain. The resident reported she calls the night nurse to ask if her scheduled pain medications could be administered. The resident stated there were concerns with the nurse being unresponsive to her request. Resident #3 stated being on a strict regime of every 4 hours to receive their pain medications to prevent oncoming pain per doctor's orders. Resident #3 said being on a consistent schedule with her pain medications helps to prevent her from feeling any additional pain. Resident #3 strongly expressed her need for nurses to wake her up to take the scheduled pain medications in order to prevent the pain. On 11/17/25 at 2:40 PM an interview was conducted with Staff B, Unit Manager (UM). The interview revealed the physician must be notified if a medication is missed or refused, and there is a high priority to attempt to wake up a resident when they have a scheduled medication to be provided in order to give the resident the opportunity to refuse if they would prefer. Staff B stated it is not up to the nurse's discretion to refuse or not provide a resident without their scheduled pain medications, the physician must be notified so they can provide instruction on whether to give a staggered dose, or to wait till the next dose to administer to the resident. Staff B stated there is no note or notification sent to the physician or family representative pertaining to the missed doses of Hydrocodone for 11/14/25 and 11/15/25, and they both should have been notified of these incidences since the resident is on scheduled pain medications. A review of Resident #3's admission record revealed an admission date of 7/30/25 with a medical diagnosis of seizures, muscle weakness, anxiety disorder, major depressive disorder, and post concessional syndrome.A review of Resident #3's orders revealed that starting on 10/27/25, the resident is to start Hydrocodone-Acetaminophen Oral Tablet 7.5-325 MG (Hydrocodone-Acetaminophen) with one tablet scheduled for every 4 hours to prevent pain.A review of Resident #3's care plan revealed no documentation related to refusing medications or to not be woken up in order to receive scheduled medications.A review of Resident #3's progress notes from 11/7/25 to 11/17/25 revealed no documentation of advising the resident's representative or physician of the missed pain medications. A review of Resident #3's quarterly Minimum Data Set (MDS) assessment, dated 10/30/25, in section C - cognitive patterns revealed a Brief Interview Mental Score (BIMS) of 15.A review of Resident #3's Medication Administration Record (MAR) for dates of 11/1/25 to 11/30/25 revealed that the resident did not receive their hydrocodone 2:00AM dose on the nights of 11/14/25 and 11/15/25. The reasons for the medication not being administered is because the nurse documented Resident #3 as sleeping for both attempts. On 11/17/25 at 2:12PM an interview was conducted with Staff A, Licensed Practical Nurse (LPN). Staff A, LPN said the physician and family representative must be contacted in order to advise them of the missed medication dose that was scheduled. Staff A, LPN said that if a resident is sleeping at the time of medication administration, the process is to gently wake up the resident to either give them their medications, or to at least give the resident the opportunity to refuse the medication, then to notify the physician and family representative of refused dose if applicable. When a medication is denied or not administered, it must be documented in the resident's progress notes as well. Staff A, LPN stated that Resident #3 is followed by pain management and uttered the importance of keeping her routine of pain medications in order to prevent pain from coming. On 11/17/25 at 3:25 PM an interview with the Interim Director of Nursing (DON) and the Assistant Director of Nursing (ADON) in training was conducted. The DON stated staff should re-attempt to wake up the resident to administer Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105688 If continuation sheet Page 3 of 4 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 105688 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at the Bay 10300 4th St N Saint Petersburg, FL 33716 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete scheduled pain medications with no specific time frame and also make a note in the resident's progress notes of the attempts. The DON confirmed there was no medication administered to the resident both dates of 11/14/25 and 11/15/25. The DON stated for both missed doses should have been administered to Resident #3 since they were scheduled. The DON said the expectation was for nurses to attempt to wake up the resident. The DON said it was not up to the nurses' discretion on when to and when not to administer medications. A review of the facility's Pain Management Guidelines revealed the following: Pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences. Identify circumstances when the pain can be anticipated. The facility staff will manage or prevent pain, consistent with the comprehensive assessment and plan of care, current professional standards of practice, and the resident's goals and preferences. The facility staff will identify key characteristics of the pain which includes: . iv. Timing. Based upon the evaluation, the facility in collaboration with the attending physician/prescriber, other health care professionals and the resident and/or the residents representative will develop, implement, monitor and revise as necessary interventions to prevent or manage each individual resident's pain beginning at admission.A review of the facility's Medication Administration Policy and Procedure revealed the following: Identify self, explain the procedure. Document task appropriately. Event ID: Facility ID: 105688 If continuation sheet Page 4 of 4