Avante at Ormond Beach, Inc

Inspectors wroteBased on kitchen food service observations, staff interviews, facility document review, and facility policy and procedure review, the facility failed to prepare, distribute and serve food in accordance with professional standards for food service safety, by failing to follow proper sanitation and food handling practices to prevent the outbreak of foodborne illness. The facility failed to ensure that the dietary staff practiced proper procedures for hand hygiene, disposable glove use, and proper sanitation practices when cleaning the meat slicer in the kitchen. Appropriate hand hygiene, food handling, and sanitation is important in health care settings serving nursing home residents due to the risk of serious complications from foodborne illness as a result of their compromised health status. Unsafe food handling practices represent a potential source of pathogen exposure.

Inspectors wroteBased on observations, resident and staff interviews, and a review of policies and procedures, the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary and comfortable living environment, by failing to 1) Keep resident care equipment functioning for one resident (#8) whose bed controls did not work, and 2) Keep the rooms clean for four (Residents #54 #39, #302, #59) of five residents receiving enteral nutrition, in a total survey sample of 36 residents and a facility census of 102. The facility failed to clean and maintain the enteral nutrition (tube feeding) pumps and poles, walls, floors and floor boards surrounding the air conditioning (AC) units and the AC units themselves in four resident rooms. These concerns could negatively impact residents' enjoyment of their environment. [...]

Inspectors wroteBased on observations, interviews, and reviews of the facility's Infection Control Program and Hand Hygiene policies, the facility's staff failed to offer or assist residents with hand hygiene before meals for five (Residents #66, #63, #102, #57, #29) of five residents who received meal trays and were unable to perform hand hygiene independently in a manner to prevent cross contamination.

Inspectors wroteBased on record review and interviews, the facility failed to develop a discharge plan that addressed all of the resident's needs post discharge, by failing to reconcile medication after discharge for one (Resident #1) of three residents reviewed for discharges, from a total sample of 8 residents.

Inspectors wroteBased on observations, interviews, record review, and facility policy review, the facility failed to ensure enteral tube syringes were replaced daily for four (Residents #4, #8, #6, and #7) of five residents receiving enteral tube feedings (TF) and failed to ensure the enteral feeding bag for one (Resident #7) resident receiving enteral TF was dated/timed to reflect contents were less than or up to 24 hours old for residents, from a total sample of 8 residents. This could result in the residents not receiving appropriate care and/or clinical complications.

Inspectors wroteBased on observations, interviews, and medical record review, the facility failed to ensure tracheostomy/respiratory care was provided to two (Residents #4 and #8) of two resident reviewed for respiratory care, by failing to follow physician orders for tracheostomy care, suction and/or oxygen tubing. This could result in the residents not receiving appropriate care and/or clinical complications.

Inspectors wroteBased on observations and interview, the facility failed to ensure current and accurate nurse staffing information was posted (facility name, the current date, the total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift) on a daily basis at the beginning of each shift.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure three (Resident #6, #7, and #8) of eight sampled residents had access to the call light while in bed.

Inspectors wroteBased on interviews, medical record review, and facility policy and procedure review, the facility failed to ensure residents were free from any significant medication errors, by failing to administer medications within the specified timeframe based on physician's scheduling orders for ten (Residents #1, #3, #4, #5, #9, #10, #11, #12, #13, and #14) of fourteen sampled residents, from a total census of 101. Failure to administer medications in a timely manner can result in a resident's inability to maintain the proper level of medication in the bloodstream to be effective; reduced functional ability; lower quality of life; hospitalization, disease progression, and/or death.

Inspectors wroteBased on observations, medical record review, interviews, and a review of the facility's policy and procedure for pressure ulcers, the facility failed to ensure that a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing, by failing to apply physician-ordered bilateral heel protectors for one (Resident #88) of two residents selected for a review of pressure ulcers, out of nine residents with pressure ulcers, from a total sample of 43 residents.

Inspectors wroteBased on observations, medical record review, and interviews, the facility failed to ensure that three (Residents #42, #8, and #18) of 12 residents receiving oxygen, from a total sample of 43 residents, had physicians' orders for the oxygen (Resident #42), and received oxygen at the flow rate ordered by the physician (Residents #8, and #18).

Inspectors wroteBased on observation and interviews, the facility failed to post the following Nurse Staffing information on a daily basis as required: (i) Facility name. (ii) The current date. (iii) The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift: (A) Registered nurses. (B) Licensed practical nurses or licensed vocational nurses (as defined under State law). (C) Certified nurse aides. (iv) Resident census. During a tour of the facility on 4/24/23 at 11:13 a.m., the Daily Staffing Projection posted in a shadow box near the entrance of the facility was observed. The date of the Nurse Staffing information was 3/20/23. (Photographic evidence obtained) During an interview with Workforce Coordinator F on 4/27/23 at 10:19 a.m., she stated she had been performing her duties since October 2022. [...]

Inspectors wroteBased on observations and interviews, the facility failed to store, prepare and serve food in accordance with professional standards for food service safety, by failing to maintain the kitchen in a safe and sanitary manner for the 102 residents who were currently residing in the facility.

Inspectors wroteBased on observations, interview and record review, the facility failed to maintain a medication error rate of less than five percent. During the medication administration observations, there were three errors and a total of thirty-five opportunities, resulting in an error rate of 8.57%.

Inspectors wroteBased on interviews, record review and facility policy and procedures, the facility failed to provide assistance with showers for one (Resident #12) of five sampled residents reviewed for activities of daily living (ADLs), out of a total sample of 33 residents.

Inspectors wroteBased on observation, interview, record reviews and a review of the policy and procedure for respiratory care, the facility failed to ensure that one (Resident # 89) of seven residents on oxygen therapy, received the correct number of liters of oxygen ordered by the physician, in a total sample of 33 residents. This could result in the resident not receiving appropriate care and/or clinical complications.