Health inspection·November 18, 2025

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few completed and showed the resident's weekly vital signs were scheduled at 11:45 a.m. (after the Amlodipine was to be administered) and the staff member had administered the vital signs at 2:07 p.m. and documented them at 2:13 p.m. (approximately 5 hours after the administration of Amlodipine). Review of Resident #16's progress notes on 11/17/25 at 1:34 p.m. did not show documentation of the resident's blood pressure at the time of Amlodipine administration on 11/17/25. An interview was conducted with, Staff A on 11/17/25 at 1:39 p.m. Staff A stated Resident #16's blood pressure had been 127/68 or something like that. Staff A reported Resident #16 was currently having chest pain and the blood pressure was lower than that something like 100/48. Staff A reported being able to look up the blood pressure (from this morning), (Staff A was informed to assist the resident by this writer), Staff A went to the computer behind the nursing station and showed the resident's dashboard was active revealing a blood pressure of 124/68 from 11/13/25. Staff A said (pronoun) didn't know why the mornings blood pressure wasn't showing up. Review of Resident #16's progress notes on 11/18/25, showed Staff A had documented on 11/17/25 at 1:58 p.m. the resident had complained of chest pain which radiated down left arm, blood pressure was taken and showed to be 100/47, the nurse practitioner was notified and ordered one dose of nitro(glycerin), the resident refused the dose, and vital signs at the time were 120/55. Review of Resident #16's assessments on, 11/18/25 at 9:26 a.m. showed a weekly skin review had been completed on 11/17 and the previous assessment was a Brief Interview for Mental Status (BIMS) evaluation completed on 11/11/25. The evaluation showed a score of 12 indicating moderate impairment. The assessments did not show staff were completing daily assessments for the resident which could have included vital signs. Review of Resident #16's blood pressure summary on 11/17/25 at approximately 1:00 p.m. showed the latest blood pressure reading was on 11/13/25 at 11:53 a.m. of 124/68. The review showed readings on 11/9, 11/7, 11/6 at 11:32 am. of 150/84 and one at 5:15 p.m. of 150/84, 11/3, 10/30, 10/27,10/23, 10/20, 10/16, 10/14, 10/13, and 10/9/25. Review of Resident #16's November MAR, Blood pressure summary, assessments and progress notes showed staff had administered amlodipine without obtaining and documenting the resident's blood pressure at the time of administration or held the medication related to the physician ordered parameters:-11/14 to 11/17/25 no blood pressure was documented and Amlodipine was administered.-11/10 to 11/12/25 no blood pressure was documented and Amlodipine was administered. On 11/10 the MAR showed nursing staff had documented not applicable NA for weekly vital signs.-11/9/25 a blood pressure of 111/69 had been recorded at 7:05 a.m. by the night shift nurse and Amlodipine was administered by the day shift nurse.-11/8/25 no blood pressure was documented and Amlodipine was administered.-11/7/25 a blood pressure of 112/66 was documented at 11:13 a.m. and showed Amlodipine had been administered.-11/4-11/5/25 no blood pressure was documented and Amlodipine had been administered.-11/1-11/2/25 no blood pressure was documented and Amlodipine had been administeredThe review showed out of 17 opportunities Amlodipine had been administered 15 times without documentation of blood pressure at the time of administration, twice Amlodipine had been administered when blood pressure was outside of parameters and should have been held. Review of Resident #16's follow up Cardiology physician visit on 11/3/25 at 4:10 p.m. showed the resident had a past medical history of paroxysmal atrial fibrillation, coronary artery disease (CAD), hypertension, and hyperlipidemia. The medical necessity for cardiology was described as Follow up for cardiac med reconcile, titrating cardiac meds, lab follow up, following volume status, adjusting diuretics as needed, monitoring hemodynamic/symptoms during and post physical therapy, and increased risk for cardiac re-admission. The assessment for essential hypertension (HTN) showed the diagnosis was controlled on Norvasc 5 mg daily, asymptomatic, SBP less than 130, avoid hypotension, and monitor vital signs. The note instructed to maintain current plan of care, including regular assessment of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105895 If continuation sheet Page 2 of 3 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 105895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aviata at Seminole 9393 Park Blvd Seminole, FL 33777 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete vital signs, labs, and overall status. Review of Resident #16's care plan showed a focus revealing the resident had altered cardiovascular status related to (r/t) hypertension, CAD, (and) history of tachycardia. The associated interventions included instructions for staff to administer medications as ordered and monitor vital signs (and) notify the MD of significant abnormalities. An additional focus revealed the resident had hypertension and took BP medications. The interventions instructed staff to Give anti-hypertensive medications as ordered. Monitor of side effects such as orthostatic hypotension and increased heart rate (tachycardia), and effectiveness. An interview was conducted with Resident #16 on 11/18/25 at 9:40 a.m. The resident stated staff do not take blood pressure on a regular basis, not daily maybe once or twice a week. The resident stated they took blood pressure yesterday (day of medication administration) after telling them (pronoun) didn't feel good. An interview was conducted with Staff B, Licensed Practical Nurse (LPN) who identified self as Resident #16's nurse, on 11/18/25 at 9:43 a.m. Staff B reported working the hall every couple of weeks but knew everyone on the hall. Staff B stated in regard to how often (pronoun) took Resident #16's blood pressure rarely. During an interview on 11/18/25 at 11:15 a.m. the Assistant Director of Nursing (ADON) stated vital signs are taken on admission, any change in condition, if skilled once a shift, if any medication (require), if blood pressure meds are taken and have parameters for blood pressure, if administering nitro take blood pressure, and obtain blood glucose before giving insulin. The ADON stated staff should de documenting blood pressure if there is a parameter, if there is a parameter the medication should have a pop-up box to put in the blood pressure, and believed the blood pressure documented in the pop-up box showed up on the MAR. Review of Resident #16's MAR was conducted and the ADON confirmed blood pressures were not documented with the administration of Norvasc. The ADON reviewed the order to monitor vital signs daily and stated if they aren't documented they weren't done. The ADON reviewed blood pressure summary and confirmed blood pressures were not done prior the administration of the resident's Amlodipine and stated the nurse had backfilled the blood pressure on 11/17 (after photo had been obtained). The ADON stated blood pressures should be taken immediately prior to the administration of the medication. Review of the policy - Administering Medications, revised April 2019, revealed Medications are administered in a safe and timely manner, and as prescribed. The policy included but was not limited to the following:-2. The director of nursing services supervises and directs all personnel who administer medications and/or have related functions.-4. Medications are administered in accordance with prescriber orders, including and required time frame.-10. The individual administering the medication checks the label THREE (3) times to verify the right resident, right medication, right dosage, right time, and right method (route) of administration before giving the medication.-11. The following information is checked/verified for each resident prior to administering medications:o a. Allergies to medications; [NAME] b. Vital signs, if necessary. Event ID: Facility ID: 105895 If continuation sheet Page 3 of 3