Ld- 3770 CERTIFIED ARTICILE NUMBER 7106 4575 fy 2080 1917 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ANE Iu 02 AGENCY FOR HEALTH CARE meee wa pee ADMINISTRATION, Cor An MES CUE BE Petitioner, v. SWEET HOME MANOR, INC., d/b/a SWEET HOME MANOR, INC., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against SWEET HOME MANOR, INC., d/b/a SWEET HOME MANOR (hereinafter “Respondent”), pursuant to Chapter 400, Part III, and section 120.60, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION 1. This is an action to impose three (3) administrative fines against the Respondent, totaling THREE THOUSAND DOLLARS ($3000), pursuant to Sections 400.414(1) 400.419, Florida Statutes (2001). JURISDICTION AND VENUE 2. AHCA has jurisdiction over licensure of assisted living facilities, pursuant to Chapter 400, Part III, Florida Statutes (2001). 3. Venue shall be determined pursuant to Rule 28-106.207, Fla. Admin. Code. Page | of 8 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 400, Part III, Florida Statutes (2001), and Chapter 58A-5 Fla, Admin. Code. 5. The Respondent is licensed to operate an assisted living facility; license number 7175, certificate number 9754 for 6 licensed beds; effective January 11, 2001 through November 7, 2002; located at 6405 Fortieth Avenue North, St. Petersburg, FL 33709. Asa licensee under the licensing authority of AHCA, the Respondent was at all relevant times required to comply with all applicable rules and statutes governing assisted living facilities. 6. AHCA conducted a survey of the Respondent’s facility on or about December 4, 2000. AHCA conducted a second survey at the facility on or about July 10, 2002. COUNT I RESPONDENT KEPT PRESCRIPTON DRUGS THAT WERE NOT PROPERLY LABELED OR DISPENSED ACOORDANCE WITH CHAPTERS 465 AND 499, FLA. STAT. UNCORRECTED CLASS Il DEFICIENCY FLA. ADMIN. CODE R. 584-5.0185(7)(a), §§ 400.4256, 400.414(1), 400.441, Fla. Stat, (2001) 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. AHCA conducted a Survey on or about December 4, 2000. The findings included: A. A random resident was prescribed Dilantin 100mg, 1 capsule three times daily according to the medication label. However, the MOR indicated that this medicine was being taken four times a day (7am, 12noon, Spm, and 9pm). The administrator stated in an interview that the MOR accurately reflected the health care provider's order, which apparently had been changed from the original prescription. Thus, the label was incorrect. B. This same resident was also taking Prilosec 20mg, 1 capsule every day per the pharmaceutical label. According to an 11/15/00 progress note reflecting an official telephone Page 2 of 8 CERTIFIED ARTICILE NUMBER 7106 4575 1294 2050 1917 order, this dosage had been increased to "20mg twice a day”. No amended pharmacy label had been procured, rendering the current label inaccurate; and Cc. In addition, the above-referenced resident was taking Thioridazine 25mg, | capsule twice daily per the corresponding label. The administrator stated that as of 10/25/00, this order had been changed to 2 capsules three times a day; a telephone order verified this in addition to a MOR with 7am, 12noon and Spm indicated as times this medication was being taken. Thus, the label on the container did not reflect the current order being followed. 9. Based upon the forgoing, the Respondent violated Fla. Admin. Code R. 58A- 5.0185(7)(a), which permits the Respondent to keep prescription drugs only when those prescription drugs are properly labeled and dispensed. This rule was promulgated pursuant to §§ 400.4256, 400.441, Fla. Stat. (2001). 10. AHCA assigned a mandatory correction date of December 7, 2000. 11. On or about July 10, 2002, AHCA conducted a second survey. The findings included the following: A. Medication review during the 7/10/02 survey revealed the following discrepancies: a) Resident #2 was taking Miralax Powder, 1 tablespoon with water every day according to the pharmacy label. Review of the medication observation record (MOR), as well as interview with staff indicated that this drug was to be given on an as needed basis; and b) Resident #2 was taking Dilantin 100mg, 1 capsule 4 times/day per the pharmacy. label. Review of the 7/02 MOR, interview with staff, and review of a 7/01 physician order “indicated that this medication was to be given 3 times/day. Both inaccuracies left this and other residents at risk of not having their clinical needs appropriately met. 12. | The Respondent left the deficiency uncorrected after the mandatory correction date. 13. Based upon the forgoing, the Respondent violated Fla. Admin. Code R. 58A- 5.0185(7)(a), which permits the Respondent to keep prescription drugs only when those prescription drugs are properly labeled and dispensed. This rule was promulgated pursuant to §§ 400.4256, 400.441, Fla. Stat. (2001). 14. The above-referenced violation is grounds for the imposition of the administrative Page 3 of 8 fine, pursuant to §§ 400.4256, 400.441, 400.441(1)(k), 400.414(1), 400.419(1)(c), Fla. Stat. (2001). This is a Class III violation subjecting the facility to a fine of ONE THOUSAND DOLLARS ($1000), pursuant to Section 400.419 (1)(c), F.S., (2001). CLAIM FOR RELIEF FOR COUNT | WHEREFORE, the Agency requests the following relief: 15. Factual and legal findings in favor of the Agency on Count I and; 16. Uphold the imposition of the $1000 administrative fine. COUNT I RESPONDENT FAILED TO ENSURE THAT PERSONNEL RECORDS CONTAIN VERIFICATION OF FREEDOM FROM COMMUNICABLE DISEASE INCLUDING TUBERCULOSIS UNCORRECTED CLASS III DEFICIENCY 400.4275(4), 400.414(1), 400.441(1) FLA. STAT (2001) CLAIM FOR RELIEF FOR COUNT II 17. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 18. AHCA conducted a survey on or about December 4, 2000. The findings included: A. Personnel records did not all contain verification of freedom from communicable i disease including tuberculosis. B. Employee file review during the 12/4/00 survey revealed that A.W. had no communicable disease statement. 19. Based upon the forgoing, the Respondent violated Fla. Admin. Code R. 58A- 5.024(2)(a), which required the Respondent to maintain, personnel records for each staff member, at a minimum, a copy of the original employment application with references furnished and verification of freedom from communicable disease including tuberculosis. This rule was promulgated pursuant to §§ 400.4275, 400.441(1)(c), and 400.441(1)(d), (Fla. Stat. 2001). 20. AHCA assigned a mandatory correction date of January 3, 2001. Page 4 of 8 CERTIFIED ARTICILE NUMBER 7106 4575 1294 2050 1917 21. On or about July 10, 2002, AHCA conducted a second survey. The findings included: A. Personnel records did not all contain verification of freedom from communicable disease including tuberculosis (TB). Findings include: C. Personnel file review during the 7/10/02 survey revealed that neither J.H. nor J.W. had any statement regarding their freedom from communicable disease including TB. 2z. Based upon the forgoing, the Respondent violated Fla. Admin. Code R. 58A- 5.024(2)(a), which required the Respondent to maintain, personnel records for each staff member, at a minimum, a copy of the original employment application with references furnished and verification of freedom from communicable disease including tuberculosis. This rule was promulgated pursuant to §§ 400.4275, 400.441(1)(c), and 400.441(1)(d), (Fla. Stat. 2001). 23. The Respondent left the deficiency uncorrected after the mandatory correction date. 24. The above referenced violation constitutes the grounds for the imposed administrative fine pursuant to §§ 400.4275, 400.414(1), 400.441(1)(c), and 400.441(1)(d), Fla. Stat. (2001). This is a Class III violation subjecting the facility to a fine of ONE THOUSAND DOLLARS ($1000.00), pursuant to § 400.419 (1)(c), Fla. Stat. (2001). CLAIM FOR RELIEF FOR COUNT IE WHEREFORE, the Agency requests the following relief: 25. Factual and legal findings in favor of the Agency on Count I and; 26 Uphold the imposition of the $1000 administrative fine. COUNT Lil RESPONDENT FAILED TO MAINTAIN DOCUMENTATION THAT ALL FACILITY EMPLOYEES MUST COMPLETE BIENNIALLY, A CONTINUING EDUCATION COURSE ON HIV AND AIDS. Page 5 of 8 UNCORRECTED CLASS II] DEFICIENCY FLA. ADMIN. CODE R. 58A-5.0191(3), S8A-5.0191(10), 58A-5.024(2)(a) 1, §§ 400.4275(4), 400.414(1), 400.441(1)(c), 400.452(2) FLA. STAT (2001) 27. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 28. AHCA conducted a survey on or about December 4, 2000. The findings included: A. Facility employees had not all necessarily completed a continuing education course on HIV and AIDS. Findings include: B. Personnel file review during the survey of 12/4/00 revealed that KB. had no documented evidence of having ever been trained in HIV or AIDS. 29. Based upon the forgoing, the Respondent violated Fla. Admin. Code R. 58A- 5.0191(3), which required the respondent to maintain documentation that all facility employees must complete biennially, a continuing education course on HIV and AIDS in accord with Fla. Admin. Code R. 58a-5.0191(10). This rule was promulgated pursuant to §§ 400.4275(4), 400.441(1)(c), 400.452(2) Fla. Stat (2001). 30. AHCA assigned a mandatory correction date of January 3, 2001. 31. On or about July 10, 2002, AHCA conducted a second survey. The findings included: A. Facility employees had not received training in HIV/AIDS. Findings include: B. Employee file review during the 7/10/02 survey found no documented evidence that either J.W. nor J.H., hired as care givers 1/01 and 8/01, respectively, had received any training in HIV/AIDS. 32. Based upon the forgoing, the Respondent violated Fla. Admin. Code R. 58A- 5.0191(3), which required the respondent to maintain documentation that all facility employees must complete biennially, a continuing education course on HIV and AIDS in accord with Fla. Admin. Code R. 58a-5.0191(10). This rule was promulgated pursuant to §§ 400.4275(4), Page 6 of 8 CERTIFIED ARTICILE NUMBER 7106 4575 1294 2050 1917 400.441(1)(c), 400.452(2) Fla. Stat (2001). 33, The Respondent left the deficiency uncorrected after the mandatory correction date. 34. The above referenced violation constitutes the grounds for the imposed administrative fine pursuant to §§ 400.4275(4), 400.441(1)(c), and 400.452(2) Fla. Stat. (2001). This is a Class III violation subjecting the facility to a fine of ONE THOUSAND DOLLARS ($1000.00), pursuant to § 400.419 (1)(c), Fla. Stat. (2001). CLAIM FOR RELIEF FOR COUNT Ii WHEREFORE, the Agency requests the following relief: 35. Factual and legal findings in favor of the Agency on Count I and; 36. Uphold the imposition of the $1000 administrative fine. NOTICE OF RIGHTS Respondent is notified that it 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 and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to: ~* Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida, 32308; Joanna Daniels, Assistant General Counsel. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. Page 7 of 8 74 Respectfully submitted this lA day of August, 2002. ssistant General Counsel FL Bar I.D. No. 0118321 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served BY CERTIFIED MAIL on August /Y , 2002 to Angela Wood, Administrator Sweet Home Manor, Inc. 6405 Fortieth Avenue North, St. Petersburg, FL 33709 Copies furnished to: Wendy Adams Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 (Interoffice Mail) JD/sr Joanna Daniels Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 (File Copy) ANNA DANIELS Assistant General Counsel Page 8 of 8

Docket for Case No: 02-003770