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STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
STATE OF FLORIDA, AGENCY FOR. HEALTH CARE ADMINISTRATION,
Petitioner,
v.
Case Nos. 2012007833
NORTHWEST CARE CENTRE, INC. d/b/a
NORTHWEST CARE CENTER III,
+--- - - - - - - - - - ·- ·.··.-··-- - -·- _ _ ,_,. _.,.,., .. ,_., _..., .,., ,. _,_
Respondent.
_.,,,., , ., _-., ·- · --· - .,_ ___,,_,, _ _ _
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ADMINISTRATIVE COMPLAINT
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COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Northwest Care Centre, Inc. d/b/a Northwest . Care Center III ("Respondent"), pursuant to Sections 120.569 and 120.57, Florida Statutes (2012), and alleges:
NATURE OF TIIE ACTION
This is an· action against an assisted living facility to revoke Respondent's licensure to operate an assisted living facility and to impose an administrative fine in the amount of nineteen thousand dollars ($19,000.00) and a survey fee of five hundred dollars ($500.00) for a total
assessment of nineteen thousand five hundred dollars ($1.9,500.00), based upon two (2) Class I and two (2) Class II deficient practices.
JURISDICTION AND VENUE
The Agency has jurisdiction pursuant to §§ 20.42, 120.60, and Chapters 408, Part II, and
429, Part I, Florida Statutes (20-11).
Venue lies pursuant to Florida Administrative Code R. 28-106.207.
Filed September 18, 2012 11:23 AM Division of Administrative Hearings
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PARTIES
3; The Agency is the regulatory authority responsible for licensure of assisted living · facilities and enforcement of all applicable federal regulations, state statutes and rules governing
assisted living facilities pursuant to the Chapters 408, Part n; and 429, Part I, Florida Statutes, and Chapter 58A-5, Florida Administrative Code, respectively.
Respondent operates a sixteen (16) bed assisted living facility located at 802 71st Street Northwest, Bradenton, Florida 34209, and is licensed as an assisted living facility, license number 8425.
Respondent was at all times material hereto a licensed facility under the licensing
authority of the Agency, and was required to comply with all applicable rules and statutes.
COUNTI
The Agency re-alleges and incorporates paragraphs (I) through (5) as if fully set forth herein.
That Florida law provides:
(t)· No resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the. Constitution of the United States as a resident of a facility. Every resident of a facility shall have the right to:
Live in a safe and decent living environment, free from abuse and neglect.
Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy.
Retain and use his or her own clothes and other personal property in his or her. immediate living quarters, so as to maintain individuality and personal
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dignity, except when the facility can demonstrate that such would be unsafe, impractical, or an infringement upon the rights of other residents.
Unrestrict.ed private communication, including receiving and sending unopened correspondence; access to a telephone, and visiting with any person of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. at a minimum. Upon request, the facility shall make provisions to extend visiting
., h_o_ur_s_fi_o_r_car egivers and out-of-town guests, and in other similar situations.
l (e) Freedom to participate in and benefit from community services and activities and to achieve the highest possible level of independence, autonomy, and
interaction within the community.
Manage his or her financial affairs unless the resident or, if applicable, the resident's representative, designee, surrogate, guardian, or attorney in fact authorizes the administrator of the facility to provide safekeeping for funds as provided ins. 429.27.
Share a room with his or her spouse if both are residents of the facility.
Reasonable opportunity for regular exercise several times a week and to be outdoors at regular and frequent intervals except when prevented by inclement weather.
. Exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, nor any attendance at religious services, shall be imposed upon any resident.
G) Access to adequate and appropriate health care consistent with established
and recognized standards within the community. Section 429.28(1)(a throughj), Florida Statutes (2011).
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That Florida law provides:
RESIDENT RIGHTS AND FACILITY PROCEDURES.
A copy of the Resident Bill of Rights as described in Section 429.28, F.S., or a summary provided by.the Long Term Care Ombudsman Council shall be posted in full view in a freely accessible resident area, and included in the admission package provided pursuant to Rule 58A-5.0181, F.A.C.
--t----------Ch) In with Section 429.28, F.S,, the facility shall have a written
grievance procedure for receiving and responding to resident complaints, and for residents to recommend changes to facility policies and procedures. The facility
· must be able to demonstrate that such procedure is implemented upon receipt of a
complaint.
The addres.s and telephone number. for lodging complaints against a facility or facility staff shall be posted in full view in a common area accessible to all residents. The addresses and telephone numbers are: the District Long-Term Care Ombudsman Counci 1(888)831-0404; the Advocacy Center for Persons with Disabilities, 1(800)342-0823; the Florida Local Advocacy Council, 1(800)342- 0825; and the Agency Consumer Hotline 1(888)419-3456.
The statewide toll-free telephone number of the Florida Abuse Hotline "1(800)96-ABUSE or 1(800)962-2873" shall be posted in full view in a common area accessible to all residents.
The facility shall have a written statement of its house rules and procedures which shall be included in the admission package provided pursuant to Rule 58A- 5.0181, F.A.C. The rules and procedures shall address the facility's policies with
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respect to such issues, for example, as resident responsibilities, the facility's alcohol and tobacco policy, medication storage, the delivery of services to residents by third party providers, resident elopement, and other administrative and housekeeping practices, schedules, and requirements.
(J) Residents may not be required to perform any work in the facility without compensation, except that facility mies or the facility contract may include a
4-------------- re w_·re m en_t th a=t r_es=i de n=ts be responsible for cleaningjheir own sleep_il!B._ar_e_as o=r _ apartments. If a resident is employed by the facility, the resident shail be compensated, at a minimum, at an hourly wage consistent with the federal minimum wage Jaw..
The facility shall provide residents with convenient access to a telephone to facilitate the resident's right to unrestricted and private communication, pursuant to Section 429.28(J)(d), F.S. The facility shall not prohibit unidentified telephone calls to residents. For facilities with a licensed capacity of 17 or more residents in which residents do not have private telephones, there shall be, at a minimum, an accessible telephone on each floor of each building where residents reside.
Pursuant to Section429.41, F.S., the use of physical restraints shall be limited to half-bed rails, and only upon the written order of the resident's physician, who shall review the order biannually, and the consent of the resident or the resident's representative. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance shall not be considered a physical restraint.
Rule 58A-5.0182(c), Florida Administrative Code.
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That on June 6, 2012, the Agency completed a complaint survey (CCR 2012005302) of Respondent's facility.
contrary to the mandates of law.
11. That on June 6, 2012 from 4:50 to 5:30 p.m., Petitioner's representatives interviewed several of Respondent's residents who indicated as follows:
a.
Resident number two (2) indicated that the resident was not happy at the facility,
That based upon observation, interviews, and the review of records, Respondent failed to provide a safe and decent· living environment, free from abuse and neglect, the same being
wanted to move from the facility, and that staff member "PT" is mean to the resident and has hurt the resident.
Resident number three (3) indicated that the resident does not like living at the · facility, staff are mean to the resident and have lied to the resident related to costs of residency, and the resident has heard of other residents being hit with·a wooden spoon.
Resident number four (4) indicated that staff member "PT" is mean, has hit the resident with a spoon, scrubbed the resident very hard during a bath, refusing to stop, and squeezed the resident's face hard.
.12. That Petitioner's representative observed, on June 6, 2012 at 6:00 p.m., Respondent's medication technician, staff member "PT," and noted as follows:
The staff member was performing a finger stick blood glucose test with resident number one (I) and proceeded to prepare a syringe with regular insulin.
The staff member was slurring her words, staggering, and appeared impaired.
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Several members from the Office of Attorney General's Medicaid Fraud Control unit were present and also observed the staff member's demeanor and actions expressing concern that the staff member appeared impaired.
The staff member was stopped from completing the administration of insulin on the resident.
That Petitioner's representative interviewed resident number one (1) at that time who
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indicated as follo-ws:
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The _resident moved into the facility in early May 2012.
Staff member "PT" had been testing the resident's blood sugars and performing insulin injections twice daily.
The resident was under the impression that staff member "PT" was a nurse.
· That Petitioner's representative reviewed Respondent's medication observation record for resident number one (1) for the months of May and June, 2012, and noted as follows:
The record was annotated that the resident was receiving regular insulin twice daily.
Staff member "PT" had initialed the records as the person providing the medication administration.
A sliding scale dosage method had been prescribed which required "PT" to make a clinical judgment of the amount of insulin to provide based on the outcome of the glucose testing.
That Petitioner's representative attempted to interview Respondent's staff member "PT" at the time of the attempted insulin administration and noted the staff member was so impaired her speech was garbled and her answers to questions were difficult to understand.
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That Petitioner's representative interviewed Respondent's shareholder, a registered nurse, on June 6, 2012, at approximately 6:30 PM, who indicated as follows:
She confirmed that staff member "PT" provided the insulin injections
b.
,_ c_.
"sometimes."
She aclmowledged that other staff had reported that "PT" appeared "messed up," but that she had been like that since she started employment about a year ago.
Wh_e_n_as_k_ed~·why_she_ was_ allowing an unlicensed stl!ff member to perform glucose testing and administration of insulin with a sliding scale which required judgment, the owner had no response.
That the above reflects respondent's failure to ensure residents reside in a safe and decent living environment free from abuse and neglect, where staff who lack the training, licensure, or competencies to administer medication s are permitted to do so and or Respondent staffed the facility with individuals who Respondent !mew or should have !mown suffered from impairments whi_ch affected the staff members ability to respond to resident needs, planned and unplanned, and or allowed staff to physically or emotionally abuse its residents..
The Agency determined that this deficient practice was a condition or occurrence related to the operation and maintenance of a provider or to the care of clients which present an imminent danger to the clients of the provider or a substantial probability that death or serious physical or emotional harm would result therefrom.
That the same constitutes a Class I offense as defined in Florida Statute 429.19(2)(a)
(20i1).
WHEREFORE, the Agency intends to impose an administrative fine in the amount of seven thousand dollars ($7,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to§ 429.19(2)(b), Florida Statutes (2012).
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COUNT JI
The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth
herein.
That Florida law provides:
Assistance with self-administration does not include:
Mixing, compounding, converting, or calculating medication doses, excep.t
for measuring a prescribed amount of liquid medication or breaking a scored tablet or crushing a tablet as prescribed.
The preparation of syringes for injection or the administration of medications by any injectable route.
Administration of medications through intermittent positive pressure breathing machines or a nebulizer.
(d} Administration of medications by way of a tube inserted in a cavity of the body.
Administration of parenteral preparations.·
IITigations or debriding agents used in the treatment of a skin condition.
Rectal, urethral, or vaginal preparations.
(h). Medications ordered by the physician or health care professional with prescriptive authority to be given "as needed," unless the order is written with specific parameters that preclude independent judgment on the part of the unlicensed person, and at the request of a competent resident.
(i) Medications for which the time of administration, the amount, the strength of dosage, the method of administration, or the reason for administration requires judgment or discretion on the part of the unlicensed person.
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Section 429.256(4), Florida Statutes (2011).
That Florida law provides:
ASSISTANCE WITH SELF-ADMINISTRATION.
For facilities which provide assistance with self-administered medication, either: a nurse; or an unlicensed staff member, who is at least 18 years old, trained to assist with self-administered medication in accordance with Rule 58A-5.0191,
F_._A_.C., and able todemonstrate to the administrator the ability to accurately read and interpret a prescription label, must be available to assist residents with self administered medications in accordance with procedures described in Section 429.256, F.S.
Assistance with self-administration of medication includes verbally prompting a resident to take medications as prescribed, retrieving and opening a properly labeled medication container, and providing assistance as specified in Section 429.256(3), F.S. In order to facilitate assistance with self-administration, staff may prepare and make available such items as water, juice, cups, and spoons. Staff may also return unused doses to the medication container. Medication, which appears to have been contaminated, shall not be returned to the container.
Staff shall observe the resident take the medication. Any concerns about the
resident's reaction to the medication shall be reported to the resident's health care provider and documented in the resident's record.
When a resident who receives assistance with medication is away from the facility and from facility staff, the following options are available to enable the resident to take medication as prescribed:
The health care provider may prescribe a medication schedule which coincides
with the resident's presence in the facility;
The medication container may be given to the resident or a friend or family member upon leaving the facility, with this fact noted in the resident's medication record;
The medication may be transferred to a pill organizer pursuant to the requirements of subsection (2), and given to the resident, a friend, or family
--+- m_em_b_er_uponleaving the facility, with this fact noted in the resident's medication record; or
Medications may be separately prescribed and dispensed in an easier to use form, such as unit dose packaging;
Pursuant to Section 429.256(4)(h), F.S., the term "competent resident" means that the resident is cognizant of when a medication is required and understands the purpose for tal<lng the medication.
Pursuant to Section 429.256(4)(i), F.S., the terms ''.judgment" and "discretion" mean interpreting vital signs and .evaluating or assessing a resident's condition. Rule 58A-5.0l 85(3), Florida Administrative Code.
(b) Notwithstanding the minimum staffing requirements specified in paragraph (a), all facilities, including those composed of apartments, shall have enough qualified staff to provide resident supervision, and to provide or arrange for. resident services in accordance with the residents scheduled and unscheduled service needs, resident contracts, and resident care standards as described in Rule SSA-5.0182, F.A.C.
Rule 58A-5.019(4)(b), Florida Administrative Code.
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That on June 6, 2012, the Agency completed a complaint survey (CCR 2012005302) of
. Respondent's facility.
That based upon observation, the review of records, and observation, Respondent failed to ensure that assistance with medication was provided in accord with law, said practice being contrary to the mandates of law.
That Petitioner's representative observed, on June 6, 2012 at 6:00 p.m., Respondent's
medication technician, staff member "PT," and noted as follows:
·-· ·- -· ·-····-···-·-·· - · -· ·-· -·
The staff member was performing a finger stick blood glucose test with resident number one (1) and proceeded to prepare a syringe with regular insulin.
The staff member was noted to be very odd acting and asked Petitioner's surveyor to come over as she was beginning to check a resident's blood sugar.
She performed the activity with great difficulty and was not able see very welJ and staggering.
A member of the Office of Attorney General's Medicaid Fraud Control unit was present and also observed the staff member's demeanor and actions and stopped her and stated, "You appear impaired."
"PT" then attempted to draw up two (2) units of regular insulin but Petitioner's representative interrupted her and inforined her she was too impaired to proceed.
Resident number one (1) indicated the ability to self-administer and was able to
perform the activity with cueing
That Petitioner's representative interviewed resident number one (1) at that time who indicated as follows:
The resident moved into the facility in early May 2012.
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Staff member "PT" had been testing the resident's blood sugars and performing insulin injections twice daily.
The resident was under the impression that staff member "PT" was a nurse.
That Petitioner's representative reviewed Respondent's medication observation record of resident number one (1) for the months of May and June, 2012, and noted as follows:
The record was annotated that the resident was receiving regular insulin twice daily.
Staff member "PT" had initialed the records as the person providing the medication administration.
A sliding scale dosage method had been prescribed which required "PT" to make a clinical judgment of the amount of insulin to provide based on the outcome of the glucose testing.
That Petitioner's representative attempted to interview Respondent's staff member "PT" at the time of the attempted insulin administration and noted the staff member was so impaired
her speech was garbled and her answers to questions were difficult to understand. ·
· 28. That Petitioner's representative interviewed Respondent's shareholder, a registered nurse, on June 6, 2012, at approximately 6:30 PM, who indicated as follows:
When informed of the medication administration practices of "PT," she at first denied the practice and then confirmed . that staff member "PT" provided the insulin injections "sometimes."
She acknowledged that other staff had reported that "PT". appeared "messed up," but that she"... is always like that ... " since she started employment about a year ago.
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When asked why she was allowing. an unlicensed staff member to perform glucose testing and administration of insulin with a sliding scale which required judgment, the owner had no response.
29. That Petitioner's representative noted that staff had completed required medication training as verified by a certificate dated April 15, 2011, from Vanguard and performed by an registered nurse.
--+-----3_0_. T_h_at_It_e sp'--o_n_d_en_t_'s_Policy a11.d Procedure_ for. medication administration clearly states injections or preparation of syringes is not allowable for the medication technicians.
That the above reflects Respondent's failure to ensure that assistance with self administration of medications was performed in accord with the requirements of law wh!lre Respondent knowingly permitted the routine administration of medications to a resident by an
. individual who lacked licensure, expertise, or competency to do so, placing a resident at immediate risk of medication error and the health and life threatening results of any such error.
.The Agency determined that this deficient practice was a condition or occurrence related to the operation and maintenance of a provider or to the care of clients which present an imminent danger to the clients of the provider or a substantial probability that death or serious physical or emotional harm would result therefrom.
That the same constitutes a Class I offense as defined in Florida Statute 429.19(2)(a) (2011).
WHEREFORE, the Agency intends to impose an administrative fine in the amount of five thousand dollars ($5,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to§ 429.19(2)(a), Florida Statutes (2012).
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COUNT III
The Agency re-alleges and incorporates paragraphs (!) through (5) as if fully set forth herein.
That Florida law provides:
MEDICATION STORAGE AND DISPOSAL.
In order to accommodate the needs and preferences of residents and to
encourage residents to remain as indepe1,1dent as possible, residents may keep
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their medications, both prescription and over-the-counter, in their possession both
on or off the facility premises; or in their rooms or apartments, which must be kept locked when residents are absent, unless the medication is in a secure place within the rooms or apartments or in some other secure place which is out of sight of other residents. However, both prescription and over-the-counter medications for residents shall be centrally stored if:
I. The facility administers the medication;
The resident requests central storage. The facility shall maintain a list of all medications being stored pursuant io such a request;
The medication is determined and documented by the health care provider to be hazardous if kept in the personal possession of the person for whom it is prescribed;·
The resident fails to maintain the medication in a safe marmer as described in
this paragraph;
The facility determines that because of physical arrangements and the conditions or habits of residents, the personal possession of medication by a resident poses a safety hazard to other residents; or
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The facility's rules and regulations require central storage of medication and that policy has been provided to the resident prior to admission as required under Rule 58A-5.0181, F.A.C.
Centrally stored medications must be:
medication requiring refrigeration shall be refrigerated. Refrigerated medications shall be secured by being kept in a locked container within the refrigerator, by keep\ng the refrigerator locked, or by keeping the area in which refrigerator is
·lo.cated locked;
1. Kept in a locked cabinet, locked cart, or other locked storage receptacle, room, or area at all times;
3. Accessible to staff responsible for filling pill-organizers, assisting with
self-administration, or administering medication. Such staff must have ready
;
access to keys to the medication storage areas at all times; and
4:Kept separately from the medications of other residents and properly closed cir sealed.
Medication which has been discontinued but which has not expired shall be returned to the resident or the resident's representative, as appropriate, or may be centrally stored by the facility for future resident use by the resident at the resident's request. If centrally stored by the facility, it shall be stored separately
from medication in current use,. and the area in which it is stored shall be marked
"discontinued medication." Such medication may be reused if re-prescribed by the resident's health care provider.
When a resident's stay in the facility has ended, the administrator shall return
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all medications to the resident, the resident's family, or the resident's guardian unless otherwise prohibited by law. If, after notification and waiting at least 15 days, the resident's medications are still at the facility, the medications shall be considered abandoned and may disposed of in accordance with paragraph (e).
Medications which have been abandoned or which have expired must be disposed of within 30 days of beiilg determined abandoned or expired and
-+--------- disposition·-s,h--a-ll--b-e--d-o-c-u-m--ented in the re--s-i·d--ent's reco--r·d, The medication may--b- e
taken to a pharmacist for disposal or may be destroyed by the administrator or designee with one witness.
Facilities that hold a Special-ALF permit issued by the Board of Pharmacy may return dispensed medicinal drugs to the dispensing pharmacy pursuant to Rule 64Bl6-28.870, F.A.C.
Rule 58A-5.0185(6), Florida Administrative Code.
That on June 6, 2012, the Agency completed a complaint survey (CCR 2012005302) of Respondent's facility.
·37. . That based upon observation and interview, Respondent failed to ensure that medications were securely stored and or timely destroyed as required by law,
That Petitioner's representative toured the facility on June 6, 2012, and noted as follows:
At approximately 7:10. PM, a representative of Florida's Office of Attorney General's Medicaid • Fraud Control Unit (MFCU) advised the survey team of
· unsecured medications and lead the surveyor to an unlocked room adjacent to the kitchen area in the front building.
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Contained and kept in the room was medications from previous residents, current residents, and residents from the owner's other facilities, including but not limited to Haldol.
A medication cart noted in this room with lots of medications from residents here,
d.
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at the Exci!sor group home, and residents that are no longer present. Several of the medications were antipsychotics and sedatives.
,::,A._b"'l,..ac,.,,k'---¥1.,.a,..st.,,ic,_b.,,,in of unsecured medications was_lying - 11 the floor next to the kitchen counter and the bin contained assorted resident medications.
f. The facility has two (2) separate buildings containing residents.
g, The rear building has eight (8) residents resident therein and all were observed from 5:00 PM-8:30 PM to be freely moving about the property.
The front building had three (3) residents residing therein and all were observed to move about the building.
All eleven (11) residents had diagnoses of developmental disabilities or mental illness.
In the front building was a back bedroom where. one (1) of the staff members lived and, at the time of the survey, the staff member's mother and children were noted residing in the room.
That Petitioner's representative interviewed Respondent's shareholder, a registered nurse, who acknowledged that the above referenced medications are kept there, that she had not discarded the medications which were no longer in use, and she did not have an explanation why
. medications were unsecured and accessible to residents, visitors, or unauthorized staf£
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That the unfettered access to medications by residents, staff, and visitors, places residents at risk of medication abuse, medication error, medication theft, and other misuse of prescriptives, all of which could result in serious harm.
That the above reflects Respondent's failure to ensure that medications are stored in a secure manner as required by law, that medications which are expired or prescribed for persons no longer in residence are destroyed, and that medications for persons other than residents are maintained within the facili_!r, _ _s i(!_j,i-actices placing all residents at risk of medication error caused by ingestion by intent or neglect, theft of medications, or other medication caused dangers which could be presented by prescription drugs not being managed or maintained in a safe and secure manner. .
The Agency determined that this deficient practice was a condition or occurrence related to the operation and maintenance of a provider or to the care of clients which directly threaten the physical or emotional health, safety, or security of the clients, other than class I violations. § 408.813(2)(b), Fla. Stat. (2011).
That the same constitutes a Class II offense as defined in Florida Statute 429.19(2)(b) (2011).
WHEREFORE, the Agency intends to impose an administrative fine in the ainount of three thousand dollars ($3,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to§ 429.19(2)(b), Florida Statutes (4011).
COUNT IV
The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein.
That Florida law provides:
STAFFING STANDARDS.
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Minimwn staffing:
1. Facilities shall maintain the following minimum staff hours per week:
Number of Residen ts
0-5
6-15
16-25
26-35
36-45
46-55
56- 65
66-75
76-85
86-95
Staff Hours
/Wee k 168
212
253
294
335
375 ..
416
457
498
539
for every 20 residents over 95 add 42 staff hours per week.
2, At least one staff member who has access to facility and resident records in case of an emergency shall be within the facility at all times when residents are in the facility. Residents serving as paid or volunteer staff may not be left solely in charge of other residents while the facility administrator, manager or other staff
· are absent from the facility.
In facilities with 17 or more residents, there shall be at least one staff member awake at all hours of the day and night.
At least one staff member who is trained in First Aid and CPR, as provided under Rule 58A-5.0191, F.A.C., shall be within the facility at all times when residents are in the facility.
During periods of temporary absence of the administrator or manager when residents are on the premises, a staff member who is at least 18 years of age, must be designated in writing to be in charge of the facility.
Staff whose duties are exclusively building maintenance, clerical, or food
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preparation shall not be counted toward meeting the minimum staffing hours requirement.
The administrator or manager's time may be counted for the purpose of
meeting the required staffing hours provided the administrator_ is.actively involved · in the day-to-day operation of the facility, including making decisions and providing supervision for all aspects of resident care, and is listed on the facility's
;-----------===-=st=affin=sc=hed-u-le'.---·-- ·--··- --- ·- -
Only on-the-job staff may be counted in meeting the minimum staffing hours.
Vacant positions or absent staff may not be counted.
Notwithstanding the minimum staffing requirements specified in paragraph (a), all facilities, including those composed of apartments, shall have enough qualified staff to provide resident supervision, and to provide or arrange for resident services in accordance with the residents scheduled and unscheduled service needs, resident contracts, and resident care standards as described in Rule SSA-5.0182, F.A.C.
The facility must maintain a written work schedule which reflects its 24-hour staffing pattern for a given time period. Upon request, the facility must make the daily work schedules for direct care staff available to residents or representatives, specific to the resident's care.
The facility shall be required to provide staff immediately when the Agency determines that the requirements of paragraph (a) are not met. The facility shall also be required to immediately increase staff above the minimum levels established in paragraph (a) if the Agency determines that adequate supervision and care are not being provided to residents, resident care standards described in
Rule 58A-5.0182, F.A.C., are not being met, or that the facility is failing to meet the terms of residents' contracts. The Agency shall consult with the facility administrator and residents regarding any determination that additional staff is required.
When additional staff is required above the minimum, the agency shall require the submission, within the time specified in the notification, of a corrective action
-+ l=an=in=d=ic=a=tin=.hoVl'tlie increase - !affing_is!(>_be_!l_c.!ti1:_veJ and resident service _
needs will be met. The plan shall be reviewed by the agency to determine if the plan will increase the staff to needed levels and meet resident needs.
When the facility can demonstrate to the agency that resident needs are being met, or that resident needs can be met without increased staffing, modifications may be made in staffing requirements for the facility and the facility shall no longer be required to maintain a plan with the agency.
Based on th recommendations of the local fire safety authority, the Agency. may require additional staff when the facility fails to meet the fire safety standards described in Section 429.41, F.R, and Rule Chapter 69A-40, F.A.C., until such time as the local fire safety authority. informs the Agency that fire safety requirements are being met.
Facilities that are co-located with a nursing home may use shared staffing provided that staff hours are only counted once for the purpose of meeting either assisted living facility or nursing home minimum staffing ratios.
Facilities holding a limited mental health, extended congregate care, or limited nursing services license must also comply with the staffing requirements of Rule 58A-5.029, 58A-5.030, or 58A-5.031, F.A.C., respectively.
Rule 58A-5.019(4), Florida Administrative Code.
That on Jurie 6, 2012, the Agency completed a complaint survey (CCR 2012005302) of Respondent's facility.
That based upon the review of records, observation, and interview, Respondent failed to ensure adequate and qualified staff was available to. meet the needs of all the vulnerable adults, residing in the facility,. the same being contrary to the mandates oflaw.
That Petitioner's representatives toured the facility and interviewed residents on June 6, 2012, and noted as follows:•
The Respondent facility had eleven (11) residents.
Residents numbered nine (9), ten (10), and eleven (11) were all .noted to be developmentally disabled as reported by representatives of Florida's Agency for. Persons with Disability who present during the investigation..
Residents numbered nine (9), ten (10), and eleven (11) were living in the front building.
D. Residents numbered one (1), two (2), three (3), four (4), five (5), six (6), seven
, and eight (8), resided in the back building and all were interviewed by agency staff and Officers from the Attorney General's Medicaid Fraud Control Unit (MFCU).
These residents all had various diagnosis of mental illness.
At the time, the facility was staffed with one(l) staff member in each building.
The medication technician (MT) in the rear building was observed at 6:00 PM and the following was noted:
l. She slurring her words, staggering, eyes were partially closed, and she
appeared to be impaired.
At 6:00 p.m., she attempted to perform the injection of insulin to a resident . and was stopped by the nurse surveyor as she was obviously impaired and also not a licensed person and therefore disallowed from this medication administration.
The MFCU staff were so concerned about her impairment that it was determined she was unsafe to proceed with caring for the vulnerable adults
,-------------- re=s=idin ·g.in !_herear_house, and MFCU staff infortni:.d_!he shareholder one
site that the medication technician needed to be removed from her duties and she was sent home.
That Petitioner's representative interviewed Respondent's shareholder, a registered nurse, on June 6, 2012, at approximately 6:30 PM, who indicated as follows:
When informed of the medication administration practices of "PT," she at first denied the practice and then confirmed that staff member "PT" provided the insulin injections "sometimes."
She acknowledged that other staff had reported that "PT" appeared "messed up," but that she " ... is always like that ... " since she started employment about a year ago.
That Petitioner's representative interviewed Respondent's medication technician on June 6, 2012, at approximately 6:20 PM, who indicated as follows:
Three (3) male clients from Excelsior group home come to the Respondent facility daily.
Respondent's staff "take them to the day program, Mannesota Arc, then we pick them up about 2:30 PM and then they stay, watch t.v., or go outside, then they go home, around five, but sometimes they stay for dinner."
)
That a medication cart in an unsecured room adjacent to the kitchen revealed numerous medications for residents of Excelsior group home.
A staff member of Florida's Agency for Persons with Disability who was present during the investigation provided the following information related to the group home:
The group home manager/is live-in staff at Excelsior Group and report that she "has not had one day off in over two (2) months as there is no relief staff as the owner had
;--------- l=ai=d e v=erJy.=on=e o=f=fdue to lack_of funds." .. . -··- ·-· _ _ -· _ _ _ _ _
The only way she gets a break is to take the residents to the Respondent facility and that is what she has been doing quite often.
She was ready to walk out of the group home this evening, but·did not want the residents to be left alone so she turned in her resignation giving a one week notice.
She cannot handle the verbal abuse from the owner and can't stand what she is doing to the residents.
She confirmed the Respondent and Group home owner is administering B-12
injections at the Respondent facility for a resident of the group home.
That the additional residents from the group home and the tasks required to meet their supervision needs, medication needs, transportation needs, and the provision of meals places an extra burden on Respondent's staff and impairs their ability to meet the care and service needs of residents.
That the above reflects Respondent's failure to ensure that it obtained and maintained
qualified staff in sufficient quantity, training, and experience to meet the needs, planned and unplanned, of its residents.
The Agency determined that this deficient practice was a condition or occurrence related
to the operation and maintenance of a provider or to the care of clients which directly threaten
\
/ )
the physical or emotional health, safety, or security of the clients, other than class I violations. §
408,813(2)(b), Fla. Stat. (2011)..
That the same constitutes a .Class II offense as defined in Florida Statute 429.19(2)(b)
. (2011).
WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to impose an administrative fine of four thousand dollars ($4,000.00} against the Res12ondent.
COUNTY
The Agency re-alleges and incorporates paragraphs (1) through (5) and Counts I through IV as if fully set forth herein.
That pqrsuant to Section 429.19(7), Florida Statutes (2011), in addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one half of a facility's biennial license and bed fee or $500, to cover the cost of conducting initial
complaint investigations that resu.lt in the finding of a violation that was the subject of the
complainfor monitoring visits conducted nnder Section 429.28(3)(c), Florida Statues (2011), to verify the correction of the violations.
That the citation of one or more Class II deficient practices at the June 6 and 7, 2012
survey require the conduct of.a monitoring survey pursuant to law. See, Section 429.28(3)(c), Florida Statues (201i).
That Respondent is therefore subject to a survey fee of five hundred dollars ($500.00),
pursuant to Section 429.19(7), Florida Statutes (2011).
WHEREFORE, the Agency intends to impose a survey fee of five hundred dollars ($500.00) against Respondent, an assisted living facility in the State of Florida, pursuant to § 429.19(10), Florida Statutes (2011)
)
COUNT VI
The Agency re-alleges and incorporates Paragraphs one (1) through five (5) and Counts I and IV as if fully set forth herein.
That Respondent has been cited with two (2) Class I and two (2) Class II deficient practice on a survey of June 6, 2012.
That Florida law provides that in addition to the grounds provided in authorizing statutes,
ounds that may be used by the agency for denying and revoking a license or change of
. --------··-··-· ···----· ---··· ...,,_ . ------ ------ - ---
ownership application include any of the following actions by a controlling interest: (b) An intentional or negligent act materially affecting the health or safety of a client of the provider, and (c) A violation of this part, authorizing statutes, or applicable rules. Section 408.815(1)(b) and (c), Florida Statutes (2011).
That Respondent has violated the minimum requirements of law of Chapters 429, Part II, and Chapter 58A-5, Florida Administrative Code as described with particularity within this complaint.
That Respondent has a duty to maintain its operations in accord .with the minimum
requirements of law and to provide care and services at mandated minimum standards.
. That inn addition to the requirements of part II of chapter 408, the agency may deny, revoke; and suspend any license issued under this part and impose an administrative fine in the manner provided in chapter 120 against a licensee for a violation of any provision of this part, part II of chapter 408, or applicable rules, or for any of the following actions by a licensee, for the actions of any person subject to level 2 background screening under s. 408.809, or for the actions of any facility employee ... (e) A citation of any of the foJlowing deficiencies as specified in s. 429.19; 1. One or more cited class I deficiencies. 2. Three or more cited class II deficiencies. 3. Five or more cited class III deficiencies that have been cited on a single
) ,.
i
survey and have not been corrected within the times specified, ... (k) Any act constituting a ground upon which application for a license may be denied, Section 429.14(1)(e and k), Florida Statutes (2012).
That the above reflects grounds for which the Agency may revoke Respondent's licensure to operate and assisted living facility in the State of Florida.
That based thereon, individually and collectively, the Agency seeks the revocation of the
WHEREFORE, the Agency intends to revoke the license of the Respondent to operate an
· assistedliving facility in the State of Florida.
Respectfully submitted thisU day of August, 2012.
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
The Sebring Building
525 Mirror Lake Dr. N., Suite 330 St. Petersburg, Florida 33701 Telephone: (727) 552-1947
Facsimile: (727) 552-1440
NOTICE
The Respondent is notified that it/he/she has the right to request an administrative hearing pursuant to Sections 120,569 and 120.57, Florida Statutes. If the Respondent wants to hire an attorney, it/he/she has the right to be represented by an attorney in this matter.
Specific options for administrative action are set out in the attached Election of Rights form.
\
I
The Respondent is further notified if the Election of Rights form is not received by the Agency for Health Care Administration within twenty-one (21) days of the receipt of this Administrative Complaint, a final order will be entered.
The Election of Rights form shall be made to the Agency for Health Care Administration and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan
. Drive, Building 3, Mail Stop 3, Tallahassee, FL 323118; Telephone (850) 412.-3630.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by
U.S. Certified Mail, Return Receipt No. 7012 1010 0000 5357 3085 on August J.;;z... 2012 to
Joanne Sosbe, Administrator, Northwest Care Centre, Inc. d/b/a Northwest Care Center III, 802 71st Street Northwest, Bradenton, Florida 34209, and by regular U.S. Mail to Gregory C. Meissner, Esq., Registered Agent for Northwest Care Centre, Inc., 1111 3rd Avenue West, Suite 150, Bradenton, Florida 34250.
Copy fumishedto; Gregory C. Meissner, Esq.
Registered Agent for Northwest
Joanne Sosbe Administrator
ThJu sh II, Esq.
1//
Thomas J. Walsh II Senior Attorney
Care Centre, Inc. 1111 3rd Avenue West
Suite 150
Bradenton, Florida 34250 (Regular U.S. Mail)
Northwest Care Centre, Inc. d/b/a Northwest Care Center m'
802 71'1 Street Northwest
Bradenton, Florida 34209 (US Certified Mail)
Agency for Health Care Ad.min. 525 Mirror Lake Drive, #330 St. Petersburg, FL 33701 (Interoffice Mail)
Patricia Caufrnan Field Office Manager
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STATUS OF YO\JRITEM DATE& TIME LOCATION FEATURES
Delivered August 20, 2012, 10:33 am SAINT Certified Mail"'
PETERSBURG, FL 33701
Moved, Left no Address Augusl 16, 2012, 11:05am BRADENTON, FL
Undeliverable as August 15, 2012, 9:43am BRADENTON, FL 34209 Addressed
Arrival at Unit August 15, 2012, 8:36am BRADENTON, FL 34209
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| Issue Date | Document | Summary |
|---|---|---|
| Apr. 17, 2013 | Agency Final Order |
