Avante At St Cloud Inc
AVANTE AT ST CLOUD INC in SAINT CLOUD, FL — inspection on August 15, 2024.
Found 12 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
self-administration assessment to ensure safety for 1 of 1 resident reviewed for self-administration
Findings
Resident #1 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included Chronic atrial fibrillation, and hypertensive chronic kidney disease with stage 1 through 4.
Her most recent Minimum Data Set assessment, dated 8/05/24, revealed a Brief Interview for Mental Status exam score of 13 out of 15, which indicated intact cognition.
On 8/12/24 at 11:55 AM, resident #1 was lying on her bed with the overbed table across her. A white plastic bin on the table contained personal items, including Hydrocortisone 1% cream. Resident #1 stated she had applied the cream herself for over one year to her private area.
On 8/12/24 at 5:21 PM, the East Wing Unit Manager acknowledged two tubes of Hydrocortisone cream, were present on the resident's bed.
The East Wing Unit Manager said the resident's husband had been to visit today, and she thought he must have brought the medications in.
She explained the resident had an order for cream because she had a rash between her legs.
The East Wing Unit Manager acknowledged the nurse should apply the treatment, as the resident was not approved or assessed to have medications at the bedside.
On 8/12/24 at 5:27 PM, the Director of Nursing (DON) stated, A resident must be assessed for self-administration [of medications], and if appropriate, then we get physician orders for the resident to perform the treatment.
The DON acknowledged those protocols were not in place for resident #1.
A review of the facility's policy and procedure for self-administration of Medication program dated 3/2/19 read, It is the policy of the facility to allow the resident and or legal representative of the resident the right to self-administer medication when it has been deemed by the interdisciplinary team that it is clinically appropriate.
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 TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE
105670 08/15/2024
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
Review of the Side Rails Informed Consent and Release dated 3/06/20 revealed the consent did not address the use of four side rails, and the document read, I understand that the side rails are used as a mobility aid and not as a physical restraint.
Documentation on the form revealed verbal consent via telephone was obtained from the family.
The DON confirmed no additional consent was obtained when the resident received the bed from Hospice, an assessment for the use of the four side rails was not identified, and there was no documentation in the resident's clinical records regarding the request of the family for the use of four side rails.
On 8/14/24 at 1:27 PM, the [NAME] Wing RN/UM stated if family requested four side rails, an assessment for the side rails was required.
The RN/UM stated she was aware four side rails were considered restraints, but explained she was not aware resident #65 had four side rails in place until made aware by RN A on 8/13/24.
Additional information provided to the field office status post exit from the survey revealed a restraint evaluation was completed for the resident on 8/19/24.
The facility's policy Freedom from Physical and Chemical Restraints issued/revised 3/02/19 read, When the use of restraints is indicated, the facility will use the least restrictive alternative for the least amount of time and document ongoing re-evaluation of the need for restraints.
105670 08/15/2024
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
administrator and other officials in accordance with state and federal law.
The document indicated
violations involving abuse were reported no later than 2 hours to the administrator and other officials (including the State Survey Agency) in accordance with State Law.
105670 08/15/2024
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
each of the Notice of Transfer or Discharge forms.
She explained nursing completed the forms, sent a
representative.
The facility was unable to provide proof the resident or resident's representative were
On 8/15/24 at 2:10 PM, the Executive Director stated she thought social services sent a copy of the Notice of Transfer or Discharge form to the resident's representative if no one was here to sign the form.
She explained she was not aware the forms were not being mailed out.
The Executive Director clarified the expectation was the resident or resident's representative was provided a copy of the Notice of Transfer or Discharge form.
105670 08/15/2024
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
Instrument effective October 2019 on page 2-41 read The RAI process, which includes the Federally mandated MDS, is the basis for an accurate assessment of nursing home residents.
The MDS information and the CAA (Care Area Assessment) process provide the foundation upon which the care plan is formulated.
105670 08/15/2024
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
Review of resident #97 's electronic medical record revealed the diagnoses of unspecified psychosis with an onset date of 6/05/24 and major depressive disorder also with an onset date of 6/05/24 The record contained a Level I PASARR screening form dated 6/03/24 which did not indicate resident #97 had a mental illness (MI) or suspected MI.
The record did not contain a Level II PASARR screening form.
On 8/15/24 at 1:05 PM, the Director of Nursing (DON) stated that new admissions from the hospital should have a level l PASARR Screening completed by the hospital before admission to the facility.
She explained when psychiatry services made a new diagnosis, the PASARR should be updated.
The DON reviewed the Level I PASARR and current diagnoses for resident #97.
The DON acknowledged the PASARR did not reflect the resident 's current MI diagnoses of unspecified psychosis and major depressive disorder.
The DON stated she did not know why the diagnoses were not listed.
105670 08/15/2024
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
documentation that showed resident declined the palm cone since 3/23/23.
She confirmed that she
105670 08/15/2024
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
prevent accidents.
interview observation and record review, the facility failed to implement accident intervention for 1 of
Findings
Resident #22 was admitted to the facility on [DATE] with diagnoses including multiple fractures of ribs, chronic obstructive pulmonary disease, and schizophrenia.
The Minimum Data Set admission assessment with assessment reference date 6/26/24 revealed resident #22 had a Brief Interview Memory score of 6/15, which indicated moderate cognitive impairment.
The assessment indicated she required moderate assistance with bed mobility and personal hygiene and maximum assistance for transfers.
A review of the Smoking assessment for resident #22 dated 7/02/24 read the resident must wear a smoking apron.
On 8/12/24 at 2:14 PM, resident #22 was observed on the smoking patio dressed in a hospital gown, sitting in a wheelchair, smoking a cigarette.
She was not wearing a smoking apron.
On 8/13/24 at 11:37 AM, resident #22 was observed smoking with Certified Nursing Assistant (CNA) J's supervision.
The resident was not wearing a smoking apron and flicked ashes from her cigarette to the ground. CNA J stated she was given the cigarettes and lighters for the residents but was not given an apron for any resident who required them.
On 8/15/24 at 9:36 AM, resident #22 was observed dressed in two hospital gowns and assisted to light a cigarette by CNA G.
The resident again was not wearing an apron. Resident #22's gown had three cigarette burns on the front.
On 8/15/24 at 10:14 AM, the East Wing Unit Manager (UM) validated the cigarette burns on the hospital gown.
The UM conducted a skin assessment and stated the resident had no injury.
The UM confirmed resident #22 should use an apron when smoking.
A review of resident #22's medical record revealed no care plan for potential injury related to smoking for staff to follow.
On 8/15/24 at 10:20 AM, the Director of Nursing (DON) stated the resident was a safe smoker with an apron at the last assessment.
A review of the facility's policy and procedure dated 1/11/19 read, If the IDT members determine that the resident is an unsafe smoker, the resident may be required to wear a protective smoking vest/apron and have a greater degree of staff supervision while smoking.
105670 08/15/2024
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
and requires continuous Oxygen was initiated on 7/10/24.
There were no interventions that
On 8/13/24 at 10:16 AM, and at 10:23 AM, resident #95 was sitting up in bed.
She confirmed she used
therapy via N/C was infusing at 8 LPM.
On 8/13/24 at 10:29 AM, Registered Nurse (RN) B stated O2 was considered medication.
The resident's physician orders were reviewed with RN B, she stated the resident had a physician order for O2 at 3 LPM continuously.
On 8/13/24 at 10:30 AM, an observation of the resident's O2 therapy was conducted in the resident's room with RN B, which showed the O2 via NC was infusing at 8 LPM.
This was confirmed by RN B, who at that time adjusted the settings down to 3 LPM. RN B stated that during change of shift she received shift report regarding O2 therapy.
She stated she did not check the resident's O2 setting this morning, and verbalized the O2 flow rate should be checked by nurses at the beginning and end of their shifts.
On 8/13/24 at 10:36 AM, the [NAME] Wing RN/Unit Manager (UM) stated nurses adjust O2 settings and should ensure O2 was at the right setting.
The RN/ UM reviewed the resident #95's physician orders and said the resident's order was for O2 at 3 LPM via N/C continually.
On 8/13/24 at 10:44 AM, the Director of Nursing (DON) stated O2 therapy was administered per physician order.
She stated her expectation for O2 therapy, was a physician order was in place, and nurses were expected to ensure the O2 therapy was being administered at the right flow rate.
The DON said nurses should check O2 settings at the beginning of the shift and periodically throughout their shift to ensure O2 therapy was being infused as ordered by the physician.
The facility's policy Oxygen issued date 9/02/2020 read, Oxygen is administered under orders of a physician .The resident's care plan shall identify the interventions for oxygen therapy, based upon the resident's assessment and orders.
105670 08/15/2024
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
Review of resident #279's medical record revealed she was admitted to the facility on [DATE] with diagnoses including open wound on the left lower leg, pain, and cellulitis (bacterial skin infection).
Review of resident #279's physician orders revealed an order dated 8/09/24 for Bactrim DS 800-160 milligrams every 12 hours for cellulitis for 10 days.
Review of resident #279's Medication Administration Record (MAR) revealed code 9 was used for the 9:00 PM dose of Bactrim on 8/09, 8/10, 8/11, and 8/12/24 and on 8/13/24 for the 9:00 AM dose.
The MAR showed the 9:00 AM dose of Bactrim was documented as given on 8/10, 8/11, and 8/12/24.
The legend showed when code 9 was used it indicated Other / See Nurse Notes.
Review of resident #279's medical record revealed a Progress Notes dated 8/10/24 which indicated on oral antibiotic Bactrim, awaiting medication to arrive.
On 8/13/24 at 9:57 AM, resident #279 stated she was prescribed an antibiotic for an infection on her legs, but she had not received it for 3 days.
On 8/15/24 at 4:38 PM, Registered Nurse (RN) O stated she entered code 9 for the 9:00 PM dose of Bactrim on 8/10, 8/11, and 8/12/24 because the antibiotic was not available.
She stated she did not know she could access Bactrim from the automatic medication dispensing machine. RN O validated she did not give resident #279 the night dose of Bactrim for 3 days.
On 8/15/24 at 6:15 PM, the Director of Nursing (DON) stated RN P did not give the 9:00 AM dose of Bactrim to resident #279 on 8/10 and 8/11/24 despite documentation showing he administered it.
She mentioned he signed a written statement which indicated he documented the medication as administered accidentally instead of documenting not administered because it was not available.
She explained she verified the automatic medication dispensing machine and confirmed Bactrim was not available those days therefore the medical record was inaccurate.
Review of the Documentation policy and procedure dated 3/02/19 revealed guidelines for timeliness in documentation to ensure accuracy.
Review of resident #276's medical record revealed she was admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy, anemia and depression.
Review of resident #276's medical record revealed Progress Notes dated 8/05/24 and 8/06/24 which showed she was alert and oriented to person, place and time.
On 8/12/24 at 12:54 PM, resident #276 stated a nurse collected a urine sample using a catheter without her consent, through force, which hurt her. Resident #276 indicated she was taken to the bathroom, but she was unable to urinate at that time.
She explained when she could not urinate, the nurse told her she would get the urine sample another way and collected the specimen using a catheter.
Review of resident #276's physician orders revealed an order dated 8/05/24 which read, U/A C&S (urinalysis and culture and sensitive).
The Treatment Administration Record (TAR) showed this was completed on 8/05/24.
There was no evidence of a physician order to collect the U/A via urinary catheterization in the medical record.
Urinary catheterization is the aseptic process of inserting a sterile hollow pliable tube into the urethra to facilitate urine drainage .
Urinary catheters should be inserted only when medically [necessary] .
Document attempts at and inadequacy of alternative methods for bladder elimination prior to insertion of the indwelling catheter .
Urinary catheters should be placed only under the direction of a physician order, (Retrieved from https://www.ahrq.gov/ on 8/22/24).
On 8/12/24 at 3:39 PM, Registered Nurse (RN) Q in broken English stated resident #276 had a physician order for a urinalysis and culture and it needed to be a sterile procedure.
She explained she told the resident the procedure and resident #276 agreed.
She stated she first asked resident #276 if she could go to the bathroom and she tried to collect the urine sample in the bathroom, but resident #276 was unable to urinate at that time.
She explained the resident returned to her bed and she told her to relax.
She waited a few minutes for resident #276, to calm down.
She stated she told resident #276, Procedure, catheterize urine and cultivo urinary, me catheterize, I can, while showing her the equipment she was going to use.
She indicated resident #276 responded yes more than once. RN Q stated she, Did not even touch her much, because the urine came out fast. I almost did not touch her.
She recalled resident #276's husband approached her during morning report at the nurse's station.
She stated he was upset and said his wife told him she was handled roughly, and was catheterized without her consent.
105670
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 105670 B.
Wing 08/15/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
Review of resident #64's medical record revealed a hospital record dated 4/25/24 showed the resident had a diagnosis of O2 dependence, and used 2 LPM of O2 via nasal cannula.
Resident #64 had a care plan for O2 therapy initiated on 6/09/23.
Interventions included the use of O2 via nasal cannula at bedtime per resident request as ordered.
On 8/15/24 at 11:03 AM, MDS coordinator #1 and MDS coordinator #2, both Licensed Practical Nurses (LPNs) stated they were both responsible for completing the MDS assessments.
They confirmed resident #64 had been on O2 since he was admitted to the facility, nor was there an order in the medical record for O2 therapy.
They explained it was therefore missed during the last Quarterly MDS assessment.
32131
4.
Resident # 95 was admitted to the facility on [DATE], with diagnoses that included chronic obstructive pulmonary disease (COPD) with acute exacerbation, asthma, malignant neoplasm bronchus or lung, cough, and dependence on supplemental oxygen.
A physician order dated 7/10/24 was for continuous O2 at 3 LPM via nasal cannula for shortness of breath.
The resident's Admission MDS assessment with ARD of 7/16/24 revealed the resident's cognition was intact with a BIMS score of 15 out of 15.
Section O for O2 therapy while a resident was not assessed.
105670
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 105670 B.
Wing 08/15/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Avante at St Cloud Inc 1301 Kansas Ave Saint Cloud, FL 34769
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.