Avante At Lake Worth, Inc.

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

qualifies for an air mattress, the Regional Nurse stated in the presence of the Administrator, All of our mattresses are considered pressure relieving except when they have a stage 2 or greater wound they will receive an air mattress. I know which resident you are referring to because this has been going on for a while, when I was the DON in the facility. We had spoken to the brother regarding the air mattress and from

a clinical standpoint he understood that the resident is on a pressure-relieving mattress that is sufficient for

the wound that she has, and he seemed to be ok. Every time we speak to Resident#1 about the air mattress she doesn't seem to have an issue. When asked, is there any other reason why she can't have an air mattress, she stated, I'm not sure, I will have to ask the DON, if the physician writes an order for it and specify that the resident needs it then we can order it. When asked does the resident have to have a pressure ulcer, she stated No, not if the doctor orders it. I know that Resident #4 had an air mattress before, but I will have to go back and look to see why she doesn't have one now. During an interview on 10/07/25 at 2:31 PM, when asked are you the Case Manager for Resident #4, he stated, Yes. When asked if he has tried to request an air mattress for the resident, he stated Yes, the insurance provided an air mattress for

the resident prior to her going to the hospital and when she returned to the facility, she didn't have it. Since I met her last year, I was informed that her insurance could provide one and we just needed a referral or an order from the facility to provide to the insurance company. I spoke to the previous social worker, the nurse and the new social worker and told them we just need an order or referral, but the response was they didn't know how to get the prescription and asked if I could get it. I told them, I am a case manager, and I can't do that. I asked multiple times if they could please get a prescription. They kept telling me they don't deal with prescriptions. I go to many facilities, and I know that there is a providing physician who can write an order.

During an interview on 10/07/25 at 4:00 PM, Resident #4's daughter stated, My mother still does not have

an air mattress. I didn't get to look at her wound on the weekend. When asked did you speak to anyone in Administration regarding the air mattress she stated, Yes, I spoke to the Administrator who told me that the wound care nurse was responsible for determining who gets an air mattress. On 10/08/25 at 2:21 PM,

during an interview with the Supervisor of the insurance company; she stated, We have tried for a long period of time to get Resident #4 an air mattress and her request for an air mattress was denied by the facility due to facility protocol. The Case Manager has been seeing the resident for about 6 months now. We have spoken with the Administrator on several occasions with a request for a physician order and clinicals to submit to the insurance company to get approval for an air mattress. We even told them that they could submit the information directly to the medical company they use, and the insurance would pay for it.

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Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/07/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avante at Lake Worth, Inc.

2501 N A St Lake Worth, FL 33460

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

to the facility with her catheter and it was inserted for about 2 weeks now.During an interview with the Director of Nursing (DON) on 10/07/25 at 4:10 PM a side-by-side review of Resident #1, #2 and #3 orders were reviewed.During review of Resident #1's orders, when asked to explain how the order: Foley Catheter: Foley Cath care every shift and PRN every 8 hours as needed for prevention was written (if it was a PRN or

a every shift order), the DON stated that the orders covered both PRN and every shift care. When asked to provide the every shift catheter care documentation, the DON was not able to find it. The only documentation available for that order was a PRN section which was also blank. When asked how they keep track of catheter care being completed or refusal if there is not a way to document through the order,

the DON stated he agreed there was no way to keep track of catheter care and was not able to provide documentation of it being completed.During review of Resident #2's orders, the DON pointed out to the surveyor, Resident #2's orders for catheter care have the option to document every shift and PRN care and Resident #2's orders should have entered this way. When asked why all Resident #2's catheter related orders were entered today and asked if Resident #2 had catheter orders from 09/26/25 (date of readmission) - 10/07/25, the DON was not able to provide an answer. When asked what was done for Resident #2 from 09/26/25 -10/07/25 the DON was not able to answer.During review of Resident #3's orders, when asked why catheter orders were placed for the Resident on 10/07/25 and what was done for

the resident since the admission date of 09/22/25, the DON could not state what happened. When asked what the process of reviewing orders for accuracy was, the DON stated, when the resident comes in, their chart gets broken down and discussed with the clinical team, they make sure the orders are there, make sure they look at diagnosis, and follow up batch orders or re-order what is need. When asked who is in charge of making sure orders are started and continued, the DON stated, I am but stated these orders were unfortunately missed. The DON agreed with the findings.

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