STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2011011674 Return Receipt Requested: v. 7009 0080 0000 0586 2289 HOPE GARDEN ASSISTED LIVING & ECC, INC. d/b/a HOPE GARDEN ASSISTED LIVING & ECC, INC., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW State of Florida, Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Hope Garden Assisted Living & ECC, Inc. d/b/a Hope Garden Assisted Living & ECC, Inc., (hereinafter “Hope Garden Assisted Living & ECC, Inc.”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes (2010), and alleges: NATURE OF THE ACTION 1. This is an action to revoke the assisted living facility license [License No.: 8658] of Respondent pursuant to Sections 408.815(1) (c), and 429.14(1) (e), Florida Statutes (2011), and to impose an administrative fine of $15,000.00 Filed December 5, 2012 1:09 PM Division of Administrative Hearings pursuant to Section 429.19, Florida Statutes (2011), for the protection of public-health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2010), and Chapter 28-106, Florida Administrative Code (2010). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code (2010). PARTIES 4, AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 429, Part I, Florida Statutes (2010), and Chapter 58A-5 Florida Administrative Code (2010). 5. Hope Garden Assisted Living & ECC, Inc. operates a 12- bed assisted ‘living facility located at 2011 N. WwW. 59°" Way, Lauderhill, Florida 33313. Hope Garden Assisted Living & ECC, Inc. is licensed as an assisted living facility under license number 8658. Hope Garden Assisted Living & ECC, Inc. was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable: rules and statutes. COUNT I HOPE GARDEN ASSISTED LIVING & ECC, INC. FAILED TO ENSURE THAT ONLY. A LICENSED STAFF CAN ADMINISTER MEDICATIONS VIA A PEG TUBE. — SECTION 429.256(4), FLORIDA STATUTES RULE 58A-5.0185(3), FLORIDA ADMINISTRATIVE CODE (ASSISTANCE OF SELF-ADMINISTRATION OF MEDICATIONS STANDARDS) CLASS I VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Hope Garden Assisted Living ECC, Inc. was cited with three (3) Class I deficiencies as the result of a complaint investigation survey that was conducted on October 5, 2011. 8. A complaint investigation survey was conducted on October 5, 2011. Based on interviews and record review, it was determined the facility failed to ensure medication administration by way of a tube inserted in a cavity of the body was performed only by licensed staff for one of three sampled residents’ (#1). This is a nursing skill that can become a potentially dangerous situation if performed by one who lacks knowledge and is not trained properly. The findings include the following. 9. Record review revealed resident (#1) was admitted to the facility on 9/28/11 with a percutaneous endoscopic gastrostomy (PEG) tube inserted into his abdomen for the purpose of administering tube feedings and medications. Review of physician orders on 9/28/11 revealed the following medication orders: a. Isosource 1.5 cal seven (7) cans in 24 hours, with 150 cc of water at time of feeding. Flush PEG tube with 25 cc of water before and after meds. b. Folic Acid 1 mg via PEG daily. c. Glyburide 2.5mg. via PEG daily. d. Simvastin 20 mg via PEG daily. e. Aricept 10 mg via PEG daily. f. Esomeprazole 40 mg via PEG daily. 10. Review of the AHCA 1823 Health Assessment form signed by the physician on admission revealed the resident required "medication administration". 11. Review of the resident's September and October 2011 medication observation record revealed unlicensed staff administering the resident's prescribed medications and feedings through the PEG tube. 12. Administering medications and feedings via Percutaneous Endoscopic Gastrostomy (PEG) tube is a nursing skill that requires specific knowledge of the human body for proper positioning of resident and establishment of PEG tube placement to ensure the tube has not dislodged or clogged. Residual of stomach content must be checked to determine if feeding was digested. Administering a feeding without this procedure performed first may result in coughing and chocking, leading to aspiration into the lungs, which results in pneumonia and demise. 13. When administering medications, after crushing permissible tablet forms and diluting with water, patency must be determined prior to and after administering medication. This is done by flushing with a specific amount of water, usually 30 cc's. The flush after the medications are administered is to allow the medications to flow into the stomach, to prevent the medications from sitting in the peg tube. This is a nursing skill that can become a potentially dangerous situation if performed by one who lacks knowledge and is not trained properly. 14, Interview with the facility aide on 10/05/11 revealed the owner/administrator is a licensed LPN, works full time ina Delray Beach nursing home, and comes to the facility once per day in the morning. The aide stated she did not know who was administering medications and feedings, although she stated she works 24 hour shifts 3 to 4 days per week. The aide stated the LPN owner/administrator is at the facility only in the morning and further stated that the owner works a full time job that is in Delray Beach. An interview conducted with the RN complainant on 10/04/11 revealed that the owner/administrator stated that he comes to the facility 3 times per day to administer resident medications. 15. Based on the foregoing facts, Hope Garden Assisted Living & ECC, Inc. violated Section 429.256(4), Florida Statutes, Rule 58A-5.0185(3), Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $5,000.00, and also gives rise to the revocation of the assisted living facility license. COUNT II HOPE GARDEN ASSISTED LIVING & ECC, INC. FAILED TO ENSURE THAT RESIDENT MET MINIMUM ADMISSION CRITERIA FOR AN EXTENDED CONGREGATE CARE PROGRAM (ECC). RULE 58A-5.030(5), FLORIDA ADMINISTRATIVE CODE (ADMISSIONS AND CONTINUED RESIDENCE STANDARDS) CLASS I VIOLATION 16. AHCA' re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 17. A complaint investigation survey was conducted on October 5, 2011. Based on record review, interview, and observation, it was determined one resident (Resident #1) of 3 residents did not meet minimum admission criteria for an extended congregate care program (ECC) in an Assisted Living Facility. The findings include the following. 18. During the review of the closed record of Resident #1, it was noted an admission date of 09/28/11 and a discharge to the hospital admission on 10/03/11 with diagnosis of Functional Decline. A review of the AHCA Form 1823 Resident Health Assessment dated 09/29/11 documented the diagnoses of A- Fibrillation, PEG Insertion, Dementia, COPD, Anemia and NIDDM (Non-Insulin Dependent Diabetes Mellitus). Further review of the form. revealed the resident required assistance with all ADL's with "Total Incapacitation". The Health Assessment form also documented on page #3 (section C) "patient is completely dependent to help by aide", Further review revealed documentation by the physician the resident required medication administration, was bedridden, and required 24-hour nursing care. 19. Continued review of the record, interview with staff, and interview with the complainant on 10/5/11 revealed the resident received nutrition & feedings via peg tube, has a Stage II or greater pressure sore, had medications and services provided by non-licensed personnel, was bed ridden, and required total care. Review of a physician order dated 9/30/11 revealed Duoderm dressings to coccyx were ordered for a Stage 2 ulcer to be changed every 48 hours or whenever necessary. There was also another order written on 9/30/11 for Xanederm dressing to coccyx Stage II ulcer change every 48 hours. 20. A’ review of the September and October 2011 Medication Administration Records and review of physician orders revealed that unlicensed staff were administering medications through -the PEG tube, administering feeding through the PEG tube, = and conducted wound care dressings for a pressure sore. The resident's record failed to document a service plan as to what licensed staff was to provide medication management, PEG tube feedings, and wound care. 21. Rule 58A-5.030(5), Florida Administrative ‘Code, requires that a person not be bedridden and not require 24-hour nursing supervision in order for the person to be appropriate to be admitted to an extended congregate care program. Resident #1 was bedridden and required 24-hour nursing care. 22. Based on the foregoing facts, Hope Garden Assisted Living & ECC, Inc. violated Rule 58A~5.030(5), Florida Administrative Code, herein classified as a Class. I violation, which warrants an assessed fine of $5,000.00, and also gives rise to the revocation of the assisted living facility license. COUNT III HOPE GARDEN ASSISTED LIVING ECC, INC. FAILED TO DOCUMENT A PRELIMINARY SERVICE PLAN PRIOR TO THE RESIDENT’S ADMISSION RULE 58A-5.030(7), FLORIDA ADMINISTRATIVE CODE (SERVICE PLANS STANDARDS) CLASS I VIOLATION 23. AHCA re-alleges and incorporates - paragraphs (1) through (5) as if fully set forth herein. 24. A complaint investigation survey was conducted on October 5, 2011. Based on record review and interview, it was determined that the facility failed to document a preliminary service plan prior to the resident's admission of whether the resident met the residency criteria, and an evaluation of the facility's ability to meet the resident's needs for one of three sampled residents (resident #1). The findings include the following. 25. Review of resident #1's record documented he was admitted to the facility 9/28/11 with a percutaneous endoscopic gastrostomy (PEG) tube located in his abdomen for the purpose of feeding and administering medications. The resident also had a Stage 2 pressure sore on the coccyx and required wound care dressings. 26. His medical examination (AHCA Form 1823) dated 9/29/11 documented the following: The section titled Physical or sensory limitations disclosed "Total Dependency/Incapacitation" Section "c™ titled resident's status indicated under item #2, the resident was bedridden, and under item #5, the resident required 24 hour nursing care. The section titled 2-B: documented the resident needed medication administration. 27. There was no documentation of a preliminary service plan prior to the resident's admission addressing the special needs. of the resident and as to whether the resident met the residency criteria for admission in an ALF. 28. There were no nursing assessments nor progress notes concerning the resident’s wound care orders, administration of the nutritional feeding via PEG tube, and administration of medications via the PEG tube. 29. Based on the foregoing facts, Hope Garden Assisted Living & ECC, Inc. violated Rule 58A-5.030(7), Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $5,000.00, and also gives rise to the revocation of the assisted living facility license. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Hope Garden Assisted Living ECC, Inc. on Counts I through III. 2. Revoke the assisted living facility license [License No.: 8658] of Hope Garden Assisted Living & ECC, Inc. based on the violation in Counts I through III. 3. Assess an administrative fine of $15,000.00 against Hope Garden Assisted Living & ECC, Inc. on Counts I through III for the violations cited above. 10 4, Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 5. Grant such other relief as this Court deems is. just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2010). Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency Clerk, Agency for. Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVI ir] A REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. 11 IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER Lourdes A. Naranjo, Fla. Bar No. 397315. Assistant General Counsel Agency for Health Care Administration 8333 N.W. 53°¢ Street Suite 300 Miami, Florida 33166 305-718-5906 Copies furnished to: Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Clinton Thompson, Administrator, Hope Garden Assisted Living & ECC, Inc., 2011 N. W. 59th Way, \ bandphsl Florida 33313 on this a day of 12 7009 0080 0000 0586 2284 COMPLETE THIS SECTION ON DELIVERY CERTIFIED M| (Domestic Mail Only; N Postage Cartitied Fae | ‘ Refurn Recolnt Fee ti (Endorgpment Required) Rostrictad Delivery Fes, E Eahteted De Poqulred) Yotal Postage & Fees cm

Docket for Case No: 12-003902

Orders for Case No: 12-003902