Health inspection·October 28, 2021

F 0686 Level of Harm - Actual harm Residents Affected - Few On 10/25/21 at 11:17 AM, the resident's assigned Registered Nurse, (RN) D said the resident had a stage II pressure ulcer on the sacrum that was acquired at the facility. He did not mention any other pressure ulcers. On 10/25/21 at 4:39 PM, the resident was on his right side with his head down, chin touching his chest and the ear touching the pillow. The resident did not have any positioning devices. The oxygen nasal cannula was in place and the resident's eyes were closed. A Nursing Progress Note on 8/19/21 revealed the resident was transferred to the hospital for low oxygen levels. He was re-admitted to the facility on [DATE] and was seen by the wound care APRN on 8/25/21. She noted the unstageable pressure ulcer on the sacrum now measured 1.8 cm x 0.9 cm x 0.2 cm. She also noted no other pressure ulcers upon re-admission. A review of the resident's care plan noted he had an unstageable pressure ulcer on the sacrum that was present on admission caused by prolonged pressure related to impaired bed mobility, incontinence . The approaches included to document any changes in skin integrity and notify licensed nurse of any new open areas, obtain weekly skin checks and notify physician of any changes in skin integrity. A review of the Weekly Skin Observation form noted the resident did not have any weekly skin checks done since he returned from the hospital on 8/21/21 until 9/15/21, indicating more than 3 weeks of weekly skin checks were missed. The evaluation dated 9/15/21 showed the resident had a new pressure ulcer to the right ear at stage III. The resident was seen by the wound care APRN on 9/15/21 and the note documented the resident had a facility acquired stage III pressure ulcer to the right ear that measured 2 cm X 0.5 cm X 0.3.Patient favors his head to the right. Necrotic tissue is noted with moderate drainage. Treatment of this wound: cleanse with wound cleanser and pat dry. Apply honey fiber to wound bed and place non-adhesive foam between the ear and pillow daily . The wound care APRN wrote the right ear pressure ulcer was Unavoidable, but did not provide a rationale as to why the ear pressure ulcer was unavoidable. A note by the wound care APRN dated 9/22/21 showed the right ear pressure ulcer was facility acquired and had worsened to Stage IV.The ear wound is unavoidable since the patient favors his head laying this way and is difficult to offload. Patient has a history of left sided stroke which could contribute to the reason he favors his right side . Contrary to the APRN's note, the resident did not have a foam device to offload his right ear from the pillow. On 10/26/21 at 3:32 PM, the resident was again observed in bed with the head of bed elevated at least 30 degrees. His head was down with his chin towards his chest and towards the right side. His right ear was touching the pillow and there was no foam between the ear and the pillow. The resident's direct care Certified Nursing Assistant, (CNA) F stated the resident, doesn't really get out of bed. The CNA voiced no concerns about the resident's positioning or about the missing foam that was supposed to between his ear and the pillow. A few minutes later, RN D entered the resident's room, checked the oxygen concentrator for flow rate and indicated the CNAs would reposition the resident but made no mention of the foam that was missing between the resident's ear and pillow. On 10/27/21 at 12:45 PM, resident #11's wound treatment was observed with the facility's Wound Care Nurse (WCN), Director of Nursing (DON), wound care APRN and a Physician Assistant. The APRN stated the right ear pressure ulcer was unstageable and measured 1.6 cm X 0.6 cm X 0.2 cm indicating the ulcer had worsened. The APRN explained the facility's therapy staff were working on an offloading device for the ear as the resident favored his right side. On 10/27/21 at 1:37 PM, the residents daughter was at the bedside and stated that after the fourth (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 2 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 0686 stroke, her father had become a resident at this facility. She said he had a pressure ulcer on his right ear, He got that here. Level of Harm - Actual harm Residents Affected - Few On 10/27/21 at 4:46 PM, the resident was in bed and had a U shaped pillow around his neck with a foam piece between the neck pillow and his right ear. The resident appeared to be positioned better, as he was midline, and not fixed to his right. Further review of the resident's care plans revealed the care plan had not been updated after the right ear pressure ulcer was discovered. There was no evidence the facility had any specific pressure offloading approaches for the right ear prior to the discovery of the pressure ulcer. The pressure injury care plan was updated to reflect the resident's right ear pressure ulcer, only when the U shaped pillow was started on 10/27/21. On 10/28/21 at 9:49 AM, RN D stated that weekly skin checks were to be completed by the nurses and for resident #11, checks were to be done on the 7 AM to 3 PM shift. He explained weekly skin checks were to be done even if the resident was being seen by the WCN. RN D stated when he first saw resident #11's right ear wound, it was a laceration. He said he put an order for a wound consult and then the Wound Nurse began assessing him. RN D stated the U shaped pillow was just put on him, yesterday, from therapy. At 9:57 AM, the South Wing UM reviewed the weekly skin checks in the electronic medical record and found weekly skin checks dated 8/3/21, 8/13/21 and 9/15/21. She could not explain why there were missing weekly skin checks between 8/13/11 and 9/15/11. She explained if weekly skin checks were missed, the DON and/or the Assistant Director of Nursing (ADON) were responsible to ensure they were completed. On 10/28/21 at 10:25 AM, a meeting was held with the Administrator, DON, WCN and Regional Nurse. The DON explained that Weekly Wound Evaluations were completed by the WCN for residents with pressure ulcers and Weekly Skin Observations were completed by the direct care nurses on all residents including those with pressure ulcers. The DON was presented with Weekly Skin Observations for resident #11, dated 8/3/21, 8/13/21 and 9/15/21. She did not explain why the resident's weekly skin checks were not done. She explained the South [NAME] UM should have ensured they were done. The Administrator verbalized that direct care nurses completed the Weekly Skin Observations, but no one verified they were completed. The DON then stated the WCN did a head to toe check on residents. The WCN stated she did not do head to toe skin check every week on residents. The WCN said she placed a piece of foam under the resident #11's ear when the pressure ulcer was first discovered and if the foam needed to be repositioned, then the direct care nurse would do it. The DON noted the foam would have to be moved when the resident was repositioned. When informed the foam was not between the resident's ear and pillow on 10/25/21 and 10/26/21, the DON responded, it should have been. The DON explained the U shaped pillow was started yesterday, 10/27/21. On 10/28/21 at 12:44 PM, a meeting was conducted with the Chief Nursing Officer (CNO), Regional Nurse and Administrator regarding concerns with the right ear pressure ulcer. The CNO explained skin assessments on resident #11 were done by the physician's APRN G. She pointed out that APRN G saw the resident on 9/13/21 and did a head to toe skin assessment. On 10/28/21 at 1:44 PM, during a telephone interview, APRN G said she reviewed her progress note dated 9/13/21 and recalled she probably looked at resident #11's ears on this visit but she didn't note it. APRN G stated she tried to do a head to toe skin assessment when she examined the resident's sacral wound, but did not do a head to toe skin assessment on every visit. She stated she did not think the resident could have voiced his preference to be on his right side. She discussed ways to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 3 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 0686 Level of Harm - Actual harm Residents Affected - Few offload the pressure to his ears including turning him from side to side. She said she was informed about the U shaped neck pillow and agreed this would offload the pressure. She stated typical offloading was turning the resident from side to side. She explained the oxygen nasal cannula could had attributed to resident #11's right ear pressure ulcer. She explained padded tubing could had been used but there was no evidence the facility had tried padded oxygen tubing. APRN G reported she did not always do a head to toe skin assessment on every resident because she would need staff to assist with turning and repositioning and that staff were not always available. She acknowledged her note on 9/13/21 did not indicate a head to toe skin assessment was done. She stated, it's considered that if it is not documented, you didn't do it. On 10/28/21 at 2:46 PM, CNA E was in the resident's room and the resident was in bed asleep with the U shaped pillow around his neck and a foam piece between his right ear and neck pillow. CNA E said she often cared for resident #11. She identified 2 staff were required to turn and reposition the resident. She explained resident #11 preferred to be on his back. She said she had not seen the foam, that was under his right ear until today and the neck pillow was new since yesterday. On 10/28/21 at 3:27 PM, a meeting was held with the Therapy Director, Physical Therapist (PT) and the Certified Occupational Therapist Assistant (COTA). The therapy discharge notes were reviewed that indicated the resident had been on therapy from 8/22/21 to 9/10/21. A goal for Occupational Therapy noted, patient will achieve midline position in bed . The discharge summary noted on 9/10/21, Poor-unable ability to achieve midline. The therapist stated the resident leaned to the right and they tried to orient him to midline. The therapist said the resident leaned to the right maybe out of habit or related to multiple strokes. They stated they tried different approaches but the resident would always shifted his head to the right side. They acknowledged resident #11 did not have any purposeful movement and could not follow instructions. The Therapy Director explained the U shaped pillow was placed on him on 10/27/21 to aid with healing the right ear pressure ulcer. The therapists did not provide an answer when asked if they were consulted about off loading the ear prior to 10/27/21. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 4 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to follow physician orders for respiratory therapy for 2 of 3 residents reviewed for respiratory care of a total sample of 35 residents, (#54, #35). Residents Affected - Few Findings: 1. Resident #54 was readmitted to the facility on [DATE] with diagnoses of cerebral infarction, acute respiratory failure, and tracheostomy. The resident's Minimum Data Set (MDS) assessment with reference date 9/26/21 revealed the resident had a tracheostomy, received oxygen therapy, and suctioning. Resident #54 had care plan dated 12/05/18 for tracheostomy related to respiratory failure. She required continuous use of supplemental oxygen and care plan included interventions to, Observe respiratory rate, depth and quality oxygen as per orders On 10/25/21 at 12:50 PM, resident #54 was noted with oxygen therapy via her tracheostomy collar at 3 liters per minute (LPM). Review of the medical record revealed resident #54's physician order dated 10/25/21 read, Oxygen continuous at 5 liters/min via tracheostomy mask . On 10/25/21 at 2:30 PM, the resident's assigned nurse, Licensed Practical Nurse (LPN) B said her assignment sheet did not indicate resident #54 had oxygen and she did not check the oxygen rate today. On 10/25/21 at 2:25 PM, LPN A checked the resident's physician order for oxygen and stated it should be at 5 LPM. LPN A then went to resident #54's room, looked at the flow rate at eye level and said, I now see it is at 3 LPM. LPN A attempted to adjust the gauge on the concentrator and said it was broken and needed to be replaced. On 10/26/21 at 4:15 PM, resident #54 was noted with oxygen therapy via her tracheostomy collar at 2.5 LPM. On 10/26/21 at 4:20 PM, LPN L checked the physician order for resident #54's oxygen and said the order was changed from 5 LPM to 3.5 LPM. LPN L proceeded to resident #54's room and acknowledged the concentrator was set at 2.5 LPM. On 10/27/21 at 4:52 PM, the Director of Nursing (DON) stated the nurses should know the orders and check the oxygen liter rate at least once per shift, and whenever in the resident's room. 2. Resident #35 was admitted to the facility on [DATE] with diagnoses of end stage heart failure, cirrhosis of the liver, dementia, abnormal finding of the lung field. The physician order sheet revealed an order dated 6/10/21 that read, oxygen at 2 liters/min via nasal cannula as needed (prn) for shortness of breath. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 5 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 0695 Level of Harm - Minimal harm or potential for actual harm The Quarterly Minimum Data Set, dated [DATE] indicated the resident was receiving oxygen and hospice care. A Care Plan dated 6/04/20 and revised on 9/09/20 and 3/11/21 read, . requires intermittent or PRN oxygen support. Goal: will maintain use of intermittent oxygen as directed . Residents Affected - Few On 10/25/21 at 12:21 PM, resident #35 was observed lying in bed. He had oxygen via nasal cannula attached to an oxygen concentrator with oxygen flow rate at 3 liters/min. On 10/25/21 at 2:22 PM, the oxygen flow rate remained at 3 liters/min. On 10/25/21 at 4:05 PM, resident #35 was in bed and the oxygen flow rate was at 3 liters/min. On 10/25/21 at 4:12 PM, Licensed Practical Nurse, (LPN) H said she was assigned to resident #35. She stated the resident should have oxygen set at 2 liters/min via nasal canula. LPN H proceeded to resident #35's room, and acknowledged the oxygen concentrator was set at 3 liters/min. The LPN requested to have the Unit Manager (UM) come to the room. She informed the UM the resident's order for oxygen was for 2 liters/min and the UM verified the oxygen concentrator was set at 3 liters/min. The UM stated the expectation was that nurses check the oxygen concentrator at the start of the shift and periodically throughout the shift to ensure it was on the correct flow rate. Policy and Procedure: Physician Services dated 3/02/19 and revised 3/02/19 stated, 8. All physician orders will be followed as prescribed . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 6 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that pain management was provided consistent with professional standards of practice for 1 of 1 sampled resident, (#11) in a total sample of 35 residents. Residents Affected - Some Findings: The National Pressure Injury Advisory Panel (NPIAP) redefined the definition of a pressure injury (formerly pressure ulcer) in 2016. The updated staging system includes the following definitions: Pressure Injury: A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence .Stage 4 Pressure Injury: Full-thickness skin and tissue loss . If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury (www.npiap.com). Resident #11 was admitted to the facility on [DATE] and re-admitted on [DATE] from an acute care hospital with diagnoses of strokes, dysarthria, malignant neoplasm of sigmoid colon, unstageable pressure ulcer of sacral region, diabetes type 2, gastrostomy, protein calorie malnutrition and pain. Review of the hospital medical records revealed a history and physical dated 8/1/21 that read, patient is nonverbal and non-communicative admitted to the hospital with altered mental status nearly vegetative state. Patient is not a candidate for any aggressive cardiac intervention outcomes of this patient is exceedingly poor. The most recent Minimum Data Set (MDS) assessment dated [DATE] showed resident #1's cognition was rarely/never understood. The resident was totally dependent on 1-2 persons for all activities of daily living (ADL) and was bedbound. Within the last 5 days prior to the MDS assessment, the resident had not received any scheduled or prn (as needed) pain medication and received no non-medication interventions for pain. The staff assessment for pain did not show any non-verbal sounds, facial expressions, or protective body movements for pain. A care plan dated 8/6/21 for potential alteration in comfort related to muscle weakness, sacral and ear wounds noted pain is often displayed by changes in body mechanics, i.e., tightening/stiffening, etc.rather than with facial movement/grimaces which are more a form of acknowledgement/communication than pain/discomfort include interventions to, Evaluate for nonverbal indicator of pain including but not limited to body tensing/stiffening, moaning, rapid/increased breathing and or/restlessness and evaluate the effectiveness of pain control and document, notify MD [Medical Doctor] if pain control is ineffective, and medicate for pain as ordered. The care plan revised 10/12/21 for unstageable pressure ulcer sacrum and stage 3 pressure ulcer right ear did not address potential for pain caused by dressing changes/wound care. There were no interventions to address potential for pain during wound care such as observe for non-verbal signs of increased discomfort with wound care. There were no goals mentioned to ensure resident #11's comfort would be maintained during wound care performed by nurses. According to the most recent MDS assessment and weekly wound evaluation forms, resident #11 was admitted with unstageable pressure ulcer/injury to his sacrum and developed a stage 3 pressure ulcer/injury of the right ear in the facility as of 9/15/21. The ear wound worsened and became a stage IV as of 9/23/21. The care plan for pressure ulcers did not address the potential for pain during wound (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 7 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 care/procedures. Level of Harm - Minimal harm or potential for actual harm Review of the facility Weekly Wound Evaluation form dated 10/25/21 revealed presence of the following wounds: Right ear facility acquired wound measuring 2 centimeters (cm) by 0.3 cm by 0.3 cm deep with 30% granulation tissue and 70%. The pressure unstageable pressure ulcer on the sacrum measured 1.5 cm by 1.3 cm by 0.1 cm deep with 10% granulation and 90% eschar. Residents Affected - Some On 10/26/21 at 4 PM, resident #11 was observed resting in bed and appeared asleep with no signs of distress or discomfort noted. On 10/27/21 at 11:02 AM, the Wound Care Advance Practice Registered Nurse (APRN) M and Wound Care Physician Assistant (PA) N were on the North Wing of the facility rounding on residents. The APRN explained that resident # 11's ear wound was considered a stage 4 as there was no fat, muscle or bone in the ear. Since cartilage is the supporting structure, her guidance was to classify the wound as a Stage IV. The APRN indicated she had a busy schedule today and would see resident #11 later. She indicated she had another facility to visit after this one. On 10/27/21 at 12:45 PM, an observation of resident #11's wound care was conducted with the Wound Care Nurse (WCN), APRN-M, Physician Assistant and the Director of Nursing (DON). The APRN and WCN proceeded to turn the resident onto his left side and the DON began to remove the soiled brief. During turning the resident was observed with facial grimacing and slightly tightened his upper body. After the soiled brief was removed an observation of sacral wound revealed moist wound with yellow slough and surrounding pinkish/red tissue. The APRN proceeded to measure the sacral wound and called out the following measurements to the PA, 1.6 centimeters (cm) x 1.3 cm x 0.1 cm deep. During the procedure the WCN was holding the resident onto his left side while the APRN proceeded to clean the wound with normal saline (NS). The residents' facial expressions of wincing/grimacing became more exaggerated, as did tightening of the upper torso and he started moaning. The staff were asked to stop and were questioned whether the resident was medicated for pain prior to wound care. The staff continued with the dressing change and remarked that this was his usual during wound care. Staff indicated they thought he had Tylenol but could not say what time it was given or if they waited long enough for it take effect. The staff then positioned the resident onto his back and proceeded to do the wound care to his right ear. The ear wound appeared moist pink/red in color. The APRN called out the wound measurements to the PA of 1.7 cm x 0.6 cm x 0.2 cm deep. When the staff started to clean the ear wound with NS the resident again had increased grimacing, wincing, moaning and started to shake his head back and forth. The staff were again asked again to stop the procedure but proceeded with the wound care. The DON was asked why wound care was not stopped and she remarked that the physician would be called today for an order for stronger pain medication. The WCN said she did his wound care twice daily at 9 AM and between 3-4 PM. She commented that this was the resident's usual disposition during wound care. She did not provide an answer when asked why she did not get something stronger for the resident's pain sooner. The APRN and DON were interviewed post wound care outside the resident's room. The APRN said that normally during wound care, they did not turn the resident onto his left side as this caused him discomfort. She added they turned him onto his uncomfortable side so the surveyor could observe his wound. They were informed that was no requested nor acceptable or discussed prior to this observation. The APRN stated that they visited every week and would have expected the facility to pre-medicate him for pain. The APRN was asked why she did not stop the wound care and wait for staff to order stronger pain medication, she stated, I don't know, we were nervous due to being observed. On 10/27/21 at 1:45 PM, the resident's assigned Register Nurse, (RN) D checked the Medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 8 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 - Some Administration Record (MAR) and said the resident received Tylenol 325 milligrams 2 tablets via gastrostomy tube at 12:31 PM which was 14 minutes prior to wound care. The RN explained he did not see the resident in any pain when lying in bed. It is only when they are doing care. On 10/21/21 at 1:50 PM, resident #11 was observed supine resting in bed with a U shaped pillow around his neck and showed no distress or pain. On 10/27/21 at 4:32 PM, an interview was conducted with the WCN, DON, Assistant Director of Nursing (ADON) and Regional Director of Regulatory Compliance (RDRC). The ADON said she had helped with the resident's care and anytime staff touched him, he would flare his nose, raise his eyebrows, had facial grimacing and moaned at times with re-positioning. The DON said they did not feel resident #11 was in enough distress to stop the procedure and they took a break between doing the 2 wounds. The DON acknowledged resident #11's reactions escalated when they touched the wounds. The WCN said she had not checked the time Tylenol was given and did not realize that it had only been given 15 minutes prior to wound care which was not enough time to be effective for pain. On 10/27/21 at 5:29 PM, Certified Nursing Assistant (CNA) E said resident #11 was on her assignment twice per week. She said the resident tightened his shoulders and moaned a little when turned, bathed or provided care. She added that he was fine when just lying on his back. On 10/27/21 at 5:35 PM, the Director of Therapy acknowledged resident #11 was on therapy last month for positioning and comfort. She said, the resident made faces and tightened up during positioning. We would know to stop the therapy when he would resist and try to get on to his back. The Therapy Director reviewed the therapy note dated 8/23/21 regarding pain and said, the patient is unable to communicate pain or lack of. It is to be determined based on patient behavior. The Therapy Director explained, when resident #11 started to move his head back and forth that would indicate he was trying to get away from pain. On 10/28/21 at 10:26 AM an interview was conducted with the WCN, DON, Executive Director (ED) and RDRC. The ED assisted with interpreting Spanish to English for the WCN. The WCN said, it was explained to her by the APRN that facial expressions were normal for resident #11 because he had history of 4 strokes. She said she thought all staff were aware that wound rounds were being done and she assumed the resident had been medicated but did not know when the Tylenol was given. The WCN said she normally went to the units and informed nurses to give pain medications 30-45 minutes prior to wound care. The DON said, we did not feel he was experiencing any additional pain except when she was cleaning the wounds and it was not for a prolonged period that he had pain. Review of the medical record with the facility staff acknowledged resident #11's pain was not addressed in the comprehensive care plan regarding potential for pain during wound care. The WCN stated, because he had never showed true discomfort it was not included in the plan of care. The staff acknowledged the Weekly Wound Evaluation assessment done by the WCN on 8/4, 9/13, 8/19, 8/27, 9/3, 9/10, 9/17, 9/23, 9/30, 10/8, and 10/15/21 were all inaccurate as the nurse documented the resident was cognitively intact and thus the assessment for no verbal signs of pain was not triggered/nor completed. The DON was asked if she checked the WCN's documentation and stated, I am just one person. The facility staff acknowledge the resident was not able to verbalize pain and that his facial expressions were a sign of discomfort as the resident did not know if staff were doing wound care or changing his brief. On 10/28/21 at 1:59 PM, during a telephone interview, the primary care physician's APRN G said the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 9 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete resident was vegetative and his pain was assessed by non-verbal indicators such as facial grimacing, body tensing, resisting care or becoming rigid. She added if pain medication was given after wound care, it's too late. The APRN added, it is a priority for him not to be in pain. Review of the facility policy and procedure for pain management revised 3/2/19 read, each resident receives necessary care and services in accordance with professional standards of practice The facility must ensure that pain management is provided to residents Behavioral signs and symptoms that may suggest the presence of pain include .Resisting care .Facial expressions: grimacing .Sighing, groaning Assessment and evaluation by appropriate member of the interdisciplinary team may include .Determining factors that may make the pain better or worse the interdisciplinary team is responsible for developing a pain management regiment .If when re-evaluating, findings indicate pain is not adequately controlled, revise the pain management regimen and plan of care as indicated Event ID: Facility ID: 106027 If continuation sheet Page 10 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to ensure dishes were washed at the appropriate temperature, as per the data plate and manufacturer's instructions. Residents Affected - Some Finding: On 10/25/21 at 9:25 AM, Dietary Aide K placed a dish rack containing dishes into the dish machine. The dial on the dish machine showed temperature at 150 degrees Fahrenheit (F). The Data Plate on the machine, noted the wash temperature should be 160 degrees F. Dietary Aide K placed another rack of dishes into the dish machine and the wash temperature rose to 152 degrees F. Dietary Aide K said she started washing dishes at 9:20 AM and had already stored dishes that she had washed. The Regional Dietary Director acknowledged the wash temperature should be 160 degrees F. and the final rinse temperature should be 180 degrees F. The Certified Dietary Manager (CDM) produced the temperature log book for the dish machine dated 10/25/21 which noted the wash temperature should be at 160 degrees F. and the final rinse should be 180 degrees F. The Food and Drug Administration 2017 Food Code notes in section 4-501.15A, that a warewashing machine and its auxiliary components shall be operated in accordance with the machines data plate and other manufacturer's instructions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 11 of 12 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 106027 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avante at Orlando Inc 2000 North Semoran Boulevard Orlando, FL 32807 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to ensure garbage and refuse was disposed in a sanitary manner. Residents Affected - Some Finding: On Monday, 10/25/21 at 9:25 AM, an uncovered dumpster was observed located at the back of the facility. The dumpster did not have a cover lid. The Certified Dietary Manager (CDM) said the dumpster was used by maintenance. The maintenance dumpster contained picture frames, old furniture, clear trash bags containing paper, food cartons and juice cups. The CDM stated that food items should not be in this dumpster. The Maintenance Assistant arrived at the site and acknowledged that food refuse should be in the regular dumpster and not in the maintenance dumpster. The CDM stated food and food cartons should be in the closed dumpster to prevent rodents and pests. The Food and Drug Administration's 2017 Food Code refers to the use of outside receptacles for waste in chapter 5-501.15(A). Receptacles and waste handling units for refuse, recyclables and returnables used with materials containing food residue and use outside the food establishment shall be designed and constructed to have tight-fitting lids, doors, or covers. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106027 If continuation sheet Page 12 of 12