Inspection·October 30, 2025

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of the facility policy, the facility failed to ensure residents were free of significant medication errors. This affected two (Residents #10 and #11) of three residents reviewed for medication administration. The facility census was 65 residents. Findings include: 1.Review of the medical record for Resident #10 revealed an admission date of 06/28/24 with diagnoses including infection and inflammation of internal right hip prosthesis, chronic obstructive pulmonary disease, alcoholic cirrhosis of liver with ascites, and hypertension. Resident #10 was discharged to the hospital on [DATE] and returned on 04/05/25. Review of the hospital discharge orders for Resident #10 revealed an order dated 04/05/25 for Levaquin (an antibiotic) 750 milligrams (mg) once daily by mouth until 05/13/25. Review of the Medication Administration Record (MAR) for Resident #10 dated April 2025 revealed Levaquin was administered twice daily on 04/06/25, 04/07/25, 04/08/25, and 04/09/25. Interview on 10/30/25 at 1:03 P.M. with the Administrator confirmed the facility staff had not administered Resident #10's Levaquin as ordered. 2. Review of the medical record for Resident #11 revealed an admission date of 09/17/25 with diagnoses including nontraumatic subarachnoid hemorrhage, atrial fibrillation, and chronic obstructive pulmonary disease. Resident #11 was discharged to the hospital on [DATE] and returned on 10/23/25. Review of the hospital discharge orders for Resident #11 revealed an order dated 10/23/25 revealed to hold Eliquis (an anticoagulant) 5 mg until 10/26/25 and an order for cefuroxime (an antibiotic) 500 mg twice daily by mouth for three days. Review of the MAR for Resident #11 dated October 2025 revealed Eliquis was administered once on 10/23/25 and twice on 10/24/25 and10/25/25. Further review of the MAR dated 10/23/25 to 10/30/25 revealed cefuroxime was not signed off as administered. Interview on 10/30/25 at 1:03 PM with the Administrator confirmed the facility had not administered Resident #11's Eliquis nor the cefuroxime as ordered. Review of the facility policy titled Administering Medication dated April 2019 revealed medications should be administered in accordance with prescriber orders, including any required timeframe.This deficiency represents noncompliance investigated under Complaint Number 1263206 and is a recite to the survey dated 10/21/25. Residents Affected - Few 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: 365876 Printed: 05/15/2026 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 365876 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Carriage Inn 5040 Philadelphia Drive Dayton, OH 45415 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)