STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION!” Certified Artie W Wimbe: AGENCY FOR HEALTH CARE ADMINISTRATION, SENDERS RECORD Petitioner, vs. AHCA NO. 2002040251 AVANTE AT LEESBURG, INC., D/B/A AVANTE AT LEESBURG, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through its undersigned counsel, and files this Administrative Complaint against AVANTE AT LEESBURG, INC., D/B/A AVANTE AT LEESBURG (“Respondent”), pursuant to Section 120.569, and 120.57, Florida Statutes (2001), and alleges: Nature of the Action 1. This is an action to impose an administrative fine upon Respondent pursuant to Section 400.419, Florida Statutes. Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. AHCA has jurisdiction over Respondent pursuant to Chapter 400 Part III, Florida Statutes. 4. Venue vests pursuant to Rule 28-106.207, Florida Administrative Code. vr” ~~ PARTIES 5. AHCA is the regulatory agency responsible for licensure of nursing homes and enforcement of all applicable Florida laws and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title Iv, Subtitle C (as amended) ; Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code, respectively. 6. Respondent is a skilled nursing facility in the State of Florida, whose 116-bed nursing home is located at 2000 Edgewood Avenue, Leesburg, Florida 34748. Respondent is and was at all times material hereto licensed as a skilled nursing facility license number SNF1026096; certificate number 8730, effective May 13, 2002 through May 31, 2002. Respondent was subsequently issued skilled nursing facility license number SNF 1026096; certificate number 8746, effective June 1, 2002 through May 31, 2003. 7. Respondent was at all times material hereto, a licensed facility under the licensing authority of AHCA, and was required to comply with all applicable regulations, statutes and rules. COUNT I oe RESPONDENT FAILED TO MEET PROFESSIONAL STANDARDS OF QUALITY BY ITS FAILURE TO PROPERLY FOLLOW PHYSICIAN ORDERS. 42 CFR $483.20 (k) (3) (i) (2001) ; Rule 59A-4.1288, Fla. Admin. Code (2001. 8. AHCA re-alleges and incorporates by reference Paragraphs one (1) through seven (7) above as if fully set forth herein. 9. On or about March 28, 2002, AHCA conducted a Survey at Respondent’s facility. A class III deficiency was cited against Respondent based on the findings below: 2 —" ant Based on record review and staff interviews the facility did not follow physician orders on 1 of 5 residents. Findings: Review of the medical record revealed that an order for "Serum albumin now and yearly” was written as part of the admission orders on 3/11/02. Review of the medical record did not reveal that a serum albumin was performed as ordered. Interview with the administrator on 3/28/02 at 1:40 PM revealed that the serum albumin was not performed. 10. The facility was given a mandated correction date of April 28, 2002, Tl. On or about May 13, 2002, AHCA conducted a follow-up survey at Respondent’s facility. A class IIT deficiency was cited against Respondent based on the findings below: Based on record review and staff interviews the facility did not follow physician orders on 1 of 21 residents (Resident #1). Failure to follow physician orders could result in the resident in not receiving the attended therapeutic benefit, Findings: Interview with the director of nursing on 5/14/02 at 4:35 PM revealed that the order was missed and not followed. 12. Based on all of the foregoing, Respondent violated 42 CFR § 483.20 (k) (3) (i) via Rule S9A-4.1288, Florida Administrative Code, by failing to meet professional Standards of quality, by failing to properly follow and implement physician orders. 13. Pursuant to Section 400.23 (8) (c) , Florida Statutes, the foregoing is a class IIt deficiency because the agency determines it will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class IIt deficiency is subject to a civil penalty of $1,000 for an isolated deficiency, $2,000 for a patterned deficiency, and $3,000 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class If deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A citation for a class III deficiency must specify the time within which the deficiency is required to be corrected. If a class III deficiency is corrected within the time specified, no civil penalty shall be imposed. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief; a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00. c) Any other general and equitable relief as deemed appropriate. Dated: July 12, 2002 Agency for Health Care Administration ’ Jodi/C. Page, Es e, Senior Attorney NOTICE Respondent, AVANTE AT LEESBURG, INC., D/B/A AVANTE AT LEESBURG hereby is notified that Respondent has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to AHCA, Jodi c, Page, Esquire, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida, 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS oF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE ADMINISTRATIVE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY AHCA. Dated: July 12, 2002 AGENCY FOR HEALTH CARE ADMINISTRATION a Jo . Page, E e, Senior Attorney Fla. Bar. No. 0174629 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 921-0158 (fax) CERTIFICATE OF SERVICE ee ERI CE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint has been sent Certified mail (# 7106 4575 1294 2049 8842) to Avante at Leesburg, 2000 Edgewood Avenue, Leesburg, Florida 34748; this 19% day of 2002. AGENCY FOR HEALTH CARE ADMINISTRATION 1 Seer Jodi . Page, E , Senior Attorney Fla. Bar. No. 0174629 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 921-0158 (fax)

Docket for Case No: 02-003254

Orders for Case No: 02-003254