DG -3Y07 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA CASE NO. 2002027981 Vv. ALTERRA HEALTHCARE CORPORATION D/B/A ALTERRA STERLING HOUSE OF PUNTA GORDA, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW THE AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter referred to as AIICA), by and through its undersigned counsel, and files this Administrative Complaint against A)TERRA HKATTHCARE CORPORATION D/B/A ALTERRA STERLING HOUSE OF PUNTA GORDA (hareinafter referred to as “Respondcent”), pursuant. to Sections 120.569 and 120.57, Florida Statutes (2001), and alleges the tollowing: Nature of the Action 1. YThrs 38 an action to impose an administrative fine upon Respondent pursuant to Section 490.419, 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 Tli, Florida Statutes. . EXHIBIT A 4. Venue vests pursuant to Rvic 28-206.207, Florida Administrative Code. Parties 5. Pursuant to Chapter 400, part Ili, Plorida Statutes, and Rules 58A-5, Florida Administrative Code, AHCA is the licensing and entorcing authority with regard to assisted living facility laws and rules. 6. Respondent’s assisted living tacility is located al 250 Bal Harbor Boulevard, Punta Gorda, +lorida 33950. Respondent is and was at all times matcrial hereto a licensed facility under Chapter 400, Part. 171, Florida Statutes and Chapler S8A-5, Florida Administrative Code, with 60 beds and having been issued license number 8980. COUNT I RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE ONITED STATES AND By THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO MAKE EVERY REASONABLE EFFORT TO OBTAIN A CLASS I CARDIAC DRUG FOR A RESIDENT OVER A SEVEN (7) DAY PERIOD OF TIME. Chapter 58A-5.0185 Plorida Administrative Code (2001) ; and Section 400.419 Fla.Stat. (2001) /. AHCA re-alleges and incorporates by reference Paragraphs one (1) through six (6) above as if fully set forth herein. B. On or about April 9, 2002, ANCA performed a complaint invesliqation at Respondent's facility. AHCA cited Respondent based upon the findings below: Based on resident record review, interview with the phannacy, interview with a health Care provider and interview with the Dircetor of Nursing. the facility failed to make every reasonable effort to obtuin a Class | cardiac drug for seven days for 1 of 5 (Resident #5) residents sampled. The findings inchide: I. Review of Resident #5's record revealed that the resident had an order for Procan SR 500 mg. give 1 twice a day. The record further indicated that the prescription was faxed to the Jacility's pharmacy in Lakeland on 4/1/02 at 4 P.M. Further review of the record revealed the facility documented on 4/2/02, that the pharmacy planned to rcprocess the order. On 4/5/02, the facility re-faxed the order to their pharmacy. ‘he pharmacy responded that the dnig was on back order on 4/6/02, will call the doctor on Monday (4/8/02). On 4/8/02, an order was sent 1g the doctor for Procamamide Hydrochloride | gm. at 9 P.M on 4/8/02 and U gm. at 2 A.M. on 4/9/02 with a Pronesty! level in the AM then start Pronesty] 500 mp. every 6 hours. 2. Interview by telephunc with the facility's pharmacy in Lakeland at 4 P.M., revealed that the person who received the order on 4/1/02, did not fill the prescription as their pharmacy did not have the drug. Further interview revealed that this person tired to reorder the drug on 4/2/02 and that it was back ordered from the manufacturer, She then stated that she called 3 other drug clearing houses that her pharmacy deals with and they did not have the drup in stock. She then stated she called a Walgreen drug store in Lakeland and they did nat have the drug in stock. She did not indicate that she notified the facility of the unavailability of the drug. She did state she did not rotitied the doctor. She then stated that she was off and did not come back to work until 4/6/02 (Saturday) and realized that the drug still was not obtained for the resident, she called the facility and told them that she would notify the doctor on Monday (4/8/02). 3. Interview by telephone with the resident's physician revealed that he was very upset with the facility for not notifying him that the drug was not available on 4/2/02. He further stated. that the resident had a "life threatening ventricular arrhythonas.” "People with life threatening ventricular arrhythmias are at risk for imminent danger of death.” Further interview rcvcaled that he was notified that the resident had not received the drug on 4/8/02 by the phatmacy and was told that the resident had not had the drug for 3 days and that the drug was no longer bcing produced. He stated, that he personally called 3 hospitals in the Port Charlotte area and that they arc al! stocking the drug. fle received a fax from the ficility on 4/8/02 a1 4 P.M., for Procainamide Ifydrochloride } gm. to be given at 9 P.M. and then at 2 A M. on 4/9/02. fle stated that this was a loading dose of the inedication which was not what he ordered, which was a long acting form of the drug, but was told that was whai was available He further stated, that he just received the Pronestyl level rcsults {rom this morning and that the blood level was not in therapeutic range and needed to give the resident an additional loading dose of the medication. 4. Interview with the Director of Nursing al 3 P.M., revealed that they became aware of the drug not being available on 4/6/02 when the Pharmacy called them and told them the drug was not being produced, but the fax received from the pharmacy indicated that the drug was on back order. She stated, the Pharmacy told them that they would noti ty the doctor on Monday. The Director of Nursing further stated. that there were 5 different licensed nurses in the facility during the weck that the resident did not receive the medication and did not attempt to cal] the physician or attempt to cal] the local pharmacies in the area to obtain the drug. The Director of Nursing stated, that she took the resident's vital signs on Monday and they were "OK." When asked if all involved were aware that this drug was a Class | cardiac drug for life-threatening ventricular arthythmias the Director of Nursing stated, that they were well aware of the use of the drug. ‘The resident was recciving the medication for his life-threatening ventricular arrhythmias before the surveyors left the building. 9. Based on the toregoing, Respondent has violated Chapter 58A-$.0185 Florida Administrative Code (2001), by reason of the fact that Respondent failed to make every reasonabie effort to obtain a Class 1 cardiac drug over a seven (7) day period of Lime. 10. The foregoing violation constitutes a Class I violation. Class “I” violations are those conditions or occurrences related to the operation and maintenance ot a facility or to the personal care of residents which the agency determines present an imminent danger to the residents or guests of the facility or a substantial probability that death or serious physical or emotional harm would result. thezet rom. The condition or practice constituting a Class I violation shall be abated or climinated within 24 hours, unless a fixed period, as determined by the agency, is required for correction. A class I violation is subject to an administrative fine in an amount not less than $5,000 and not exceeding $10,000 for each violation. A fine may be levied notwithstanding the correction of the violation. AHCA 1s authorized to impose a tine of $5,000. 11. The facility was given a mandated correction date an accordance with Section 400.419(1) (b), Florida Statutes of May 9, 2002, . CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal) findings in tavor of AHCA. b) Impose a fine an the amount of $5,900.00, «) Any other general and equitable relief as deemed appropriate, COUNT TI STATE OF FLORIDA. RESPONDENT’ S STAFF FALLED TO EXERCISE THEIR RESPONSIBILITIES CONSISTENT WITH THEIR QUALIFICATIONS, To OBSERVE RESIDENTS, AND TO REPORT THEIR OBSERVATIONS TO THE RESIDENT’ Ss HEALTH CARE PROVIDER, Section 400.425 Fla. Stat. (2001) ; Chapter S58A-5.019 Florida Administrative Code (2001) ; and Section 400.419 Fla. Stat. (2001) 12. AHCA re valleges and incorporates by reference paragruphs one (1) through six (6) above us if ful ly set forth herein, 13. On or about April 9, 2002, aHCA performed a complaint investigation at Respondent's faci] ity. AHCA cited Respondent based upon the findi ngs below: Based on resident record review and interview with the Director of Nursing, the facility licensed nursing staff failed to notify a physician that a Class | cardiac drag was not available as ordered for 7 days for 1 of 5 (Resident #5) residents sampled. The findings include: l. Review of Resident #/5's record revealed that the resident had an order for Procan SR 500 me. give I twice a day. Procan SR is used in lile-threatomng ventricular arrythmias. ‘The record further indicated thal the Prescription was faxed to the facility's pharmacy in Lakeland on 4/1/02 at 4P M. Further review of the tecord revealed the facility documented on 4/2/02, the pharmacy plan to reprocess the order On 4/5/02, the facility re-faxed the order to their pharmacy. The pharmacy responded that the drug was on back order on 4/6/02, will call the doctor on Monday (4/8/02). On 4/8/02. an order was sent to the doctor for Procainamide Hydrochloride 1 pm. at 9 P.M. on 4/8/02 and 1 gm. at 2 A.M. on 4/9/02 with a Pronestyl level in the AM then start Pronestyl 500 mg. every 6 hours. 2. Review of the resident's Medication Observation Record (MOR) revealed that the order for Procan SR 500 ing. twice a day was on the MOR. Further review revealed that the heensed nurses were circling the medication as not being given and witting on the MOR that the medication was not available, Further review of the record revealed that there was no documentation that the licensed nurses were communicating to the physician that the medication was not available and asking for another order. ‘The record also did not contain documentation that the facility was attempting to obtain the medication Jrom) any other pharmacy in the area The only attempts to obtain the medication were from the contracted pharmacy in Lakeland. 2. Interview with the Director of Nursing at 3 P.M., revealed that they became aware of the drug not being available on 4/6/02 when the pharmacy called them and told them the drug was not being produced, but the fax received from the pharmacy indicated that the drug was on back order. She stated the pharmacy told them that they would notify the doctor on Monday. ‘Ube Dircetor of Nursing further stated, that there were 5 different licensed nurses in the facility during the week that the resident did not receive the medication and did not attempt to call the physician or attempt to call the local pharmacies in the area to obtain the drug. The Director of N ursing stated that she took the resident's vital signs on Monday and they were "OK." When asked if all involved were aware thal this drug was a Class | cardiac drug for life-threatening ventricular arrhythmias the Director of Nursing stated, that they were well aware of the use of the drug. 14. Based on the foregoing, Respondent has violated Chapter 58A-$.019 Florida Administrative Code (2001), and Section 400.425 Fla. Stat. (2001) by reason of the fact that. Respondent’s nursing staff failed to exercise their responsibilities consistent with their qualitications, by rheir failure to notify a physician that a Class 1 cardiac medication was not available as ordeced for a seven (7) day period of time. 15. The foregoing violation constitutes a Class Ul violation. Class “TI” violations are those conditions or occurrences related “to the operation and maintenance of a facility or to the personal care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than class y violations. A Class [I violation is subject Lo an administrative fine in an amount not Jess than $1,000 and not exceeding $5,000 for each violation. A citation for a Class If violation must specify the time within which the vielation is required to be corrected. AHCA is authorized to impose a fine of $1,000. 16. The facility was given a mandated correction date in accordance with Section 400 419(1)(b), Florida Statutes oft May 9, 2002. 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. ce) Any other gencral and equitable relief as deemed appropriate. Dated: July 22, 2002 Agency for Heaith Care Administration Senior Atturney Fla. Bar. No. 01/4629 NOTICE Respondent, ALTERRA HEALTHCARE CORPORATION 0/B/A ALTERRA STERLING HOUSE OF PUN'T'A GORDA hereby 15 notified that Respondent has a right to request an administrative hearing pursuant to sections 120.569 and 170.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights torm 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 0 REQUEST A HEARING WITHIN TWENTY-ONE (221) 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 22, 200? AGENCY FOR HEALTH CARE ADMINISTRATION Idec. Page, Fsq Senior Attorney Fla. Bar. No. 0174679 Pa] CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint has been sent by Certified Mail (# 7106 4575 1294 2049 8903) Lo Alterra Sterling House of Punta Gorda, 250 Ra) Harbor Boulevard, Manta Gorda, Florida 33950, this 22% day of July, 2002. AGENCY FOR HEALTH CARE ADMINISTRATION Joke C. Page, robin a , Senior Attorney Fla. Bar. No, 0174679 7727 Mahan Drive, MS#3 Tallahassee, Florida 32408 (850) 921-6362 (office) (B40) 921-0158 (fax) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: CASE NAME: State of Florida, Agency for Health Care Administration ¥:. CASE NO. : Healthcare Corporation d/b/a Alterra Sterline House AHCA Case No.: 2002027981 ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAINT PLEASE SELECT ONLY 1 OF THE 3 OPTIONS An Explanation of Rights is attached OPTION ONE (1) 6 ! do not dispute the aflegations of fact contained in the Administrative Complaint and waive my right to object or to be heard. { understand that by waiving my nights, a final order will be issued that adopts the Administrative Complaint and imposes the sanctions sought. OPTION TWO (2) 0 4 do not dispute and ! admit the allegations of fact in the Administrative Complaint, but do wish to be afforded an informal proceading, pursuant to Section 120.57(2), Florida Statutes, at which time | will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) & / do dispute the allegations of fact contained in the Administrative Complaint and request a formal hedting. pursuant to Section 120,57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings. you choose OPTION THREE (3), in order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must confarm to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. In order to preserve your right to any hearing, your Election of Rights in this matter must be received by AHCA within twenty-one (21) days from the date you receive the Administrative Complaint. If you do not respond at all within twenty-one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint if you have elected either OPTION TWO (2) or THREE (3) above and you are interested in discussing a settlement of this matter with the Agency, please also mark this block Mediation under Section 120.573, Florida Statutes, is not available in this matter. SEND NO PAYMENT NOW -- REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL YOU RECEIVE A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES. (Please sign and fill in your Current address.) . . fart reece alll, Sein Address 2-50, Dall Rivd. | Tanta Gorda, FL 33950 __ License No. and facitiy type © BY BO »/ ALE. _Prone No 14-576 -99.00 PLEASE RETURN YOUR COMPLETED FORM TO- Jodi C. Page, Requira, Senior Attorney. Agency for Health Caro AAninistration, 2727 Mahan Drave, Mail Stop #3, Tallahassea, Plorida 32308 (Note: Ovarnight Deliveries to 2727 Mahan Drivo, Building 3, Room 3416A, Tallahassea, Florida 32308-5403); Telephone Number: (850) 921-6362, FAX (850) 921-0158; TDD 1-800-955-8771. EXHIBIT B

Docket for Case No: 02-003407