STATE OF FLORIDA STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, _ Petitioner, (027 1S6d CASE NO: 2002046555 vs. 2002046556 2002045666 EMERITUS PROPERTIES V, INC. 2003000270 d/b/a STANFORD CENTRE, INC. Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Emeritus Properties V, Inc. d/b/a Stanford Centre, Inc. (hereinafter “Respondent”) and alleges the following: NATURE OF THE ACTION 1. This is an action to impose an administrative fine on Respondent pursuant to Sections 400.419(1) (c) and 400.419(9), Florida Statutes. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Section 120.569 and 120.57 Florida Statutes and Chapter 28-106 Florida Administrative Code. 3. AHCA, Agency for Health Care Administration, has jurisdiction over Respondent pursuant to Chapter 400 Part III, Florida Statutes. 4. Venue lies in Seminole County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28 Florida Administrative Code. PARTIES 5. Agency for Health Care Administration, State of Florida, is the enforcing authority with regard to assisted living facility licensure law pursuant to Chapter 400, Part III, Florida Statutes and Rules 58A-5, Florida Administrative Code. 6. Respondent is an assisted living facility located at 433 Orange Drive, Altamonte Springs, FL 32701. Respondent, is and was at all times material hereto, a licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code, having been issued license number 7103. COUNT I RESPONDENT FAILED TO MAINTAIN A DAILY UP-TO-DATE MEDICATION OBSERVATION RECORD FOR EACH RESIDENT IN VIOLATION OF Fla. Admin. Code R.58A-5.0185(5) (b) (2002) REPEAT CLASS III DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1 through (6) as if fully set forth herein. On or about August 17, 2001, a survey was conducted at Respondent’s facility. 9. Respondent failed to maintain an up-to-date medication observation record (MOR) for each resident receiving assistance with self- residents administered medication for two of two sampled (#1 & #2). The findings include: Based on record review, resident #1 had heath assessment indicating need of assistance with medications. Review of resident #2’s record revealed heath assessments indicating need of assistance with medications. Per review of MOR from July 1, 2001-dJuly 31, 2001, it was revealed that the following medications were not charted as given: Resident #1 Detrol LA 4 milligrams (antispasmodic for bladder control) 1 capsule every day-omitted 7/8/01 and 7/20/01. Remeron 30 milligrams (antidepressant) 1 tablet at bed time-omitted 7/20/01. Trazodone 50 milligrams (antidepressant) 1/2 tablet at bed time- Cipro omitted 7/20/01. 250 milligrams (antibiotic) 1/2 tablet every day- omitted 7/18/01, 7/19/01 and 7/27/01. Premarin 1.25 milligrams (hormone replacement) 1 tablet every Multi day-omitted 7/17/01. -vitamin (vitamin supplement) 1 every day-omitted 7/29/01. Resident #2 Glyburide 2.5 milligrams (diabetic) 1 tablet every morning- omitted 7/24/01. Phenobarbital 32.4 milligrams (anticonvulsant, anti- seizure) 3 tablets at bedtime-omitted 7/20/01. Enalapril Maltrate 10 milligrams (anti-hypertensive) 1 tablet every day-omitted 7/21/01 and 7/22/01. Vitamin C 500 milligrams (Vitamin supplement) 1 tablet every 10. August 17, day-omitted 7/22/01 and 7/24/01. Respondent was provided a mandated correction date of 2001. 11. On or about September 4, 2001, a survey was conducted at Respondent’s facility. At the time of this survey, the deficiency was corrected. 12. On or about December 20, 2001, a survey was conducted at Respondent’s facility. 13. Based on record review and staff interview, Respondent failed to maintain a daily up-to-date medication observation record for one of nine sampled residents. The findings include: Resident 1 was prescribed: Aspirin 1 a day, Famotidine 20mg 1 a day, Norvasc 10mg 1 a day, Triamterene w/HCTZ la day, Risperdal 3mg 1 at bedtime, Risperdal 2mg, 1 twice a day, and blood pressures twice weekly, Tuesdays and Fridays. Staff stated the resident was on leave with family after the AM medications 11/22/01 through 11/25/01. The blood pressure was not charted as taken on 11/28/01. The medication record was not charted that the medications Aspirin, Famotidine, Norvasc and Triamterene/HCTZ had been given on 11/19/01 and 11/27/01. Review of nurse’s notes revealed no further information to explain the omissions. Staff stated that she did not know what had happened either of the two days in question nor could she say for sure whether the medications had been given. Review of the 12/01 medication record for the same record showed resident was prescribed Catapres Patch, once a week and was due 12/12/01. The medication had been charted as given 12/14/01. Risperdal was out the morning of 12/20/01 and had not been given. Blood Pressure twice weekly had last been done 12/14/01 and was due 12/18/01, but had not been charted as done according to the med log. Staff took the blood pressure the day of the visit when the problem was noted. 14. Respondent was provided a mandated correction date of December 20, 2001. 15. The above actions or inactions are a violation of Rule 58A-5.0185(5) (b), Florida Administrative Code, which reguires the facility to maintain a daily up-to-date medication observation record (MOR) for each resident who receives assistance with self-administration or medication administration. A MOR must include the name of the resident and any known allergies the resident may have; the name of the resident’s health care provider, the health care provider's telephone number; the name of each medication prescribed, its strength, and directions for use; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The MOR must be immediately updated each time the medication is offered or administered. 16. Said violation constitutes the grounds for the imposed repeat Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (c), Florida Statutes, the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). FIRST UNCORRECTED CLASS III DEFICIENCY 17. On or about December 20, 2001, a survey was conducted at Respondent's facility. 18. Based on record review and staff interview, Respondent failed to maintain a daily up-to-date medication observation record for one of nine sampled residents. The findings include: Resident 1 was prescribed: Aspirin 1 a day, Famotidine 20mg 1 a day, Norvasc 10mg 1 a day, Triamterene w/HCTZ 1 a day, Risperdal 3mg 1 at bedtime, Risperdal 2mg, 1 twice a day, and blood pressures twice weekly, Tuesdays and Fridays. Staff stated the resident was on leave with family after the AM medications 11/22/01 through 11/25/01. The blood pressure was not charted as taken on 11/28/01. The medication record was not charted that the medications Aspirin, Famotidine, Norvasc and Triamterene/HCTZ had been given on 11/19/01 and 11/27/01. Review of nurse’s notes revealed no further information to explain the omissions. Staff stated that she did not know what had happened either of the two days in question nor could she say for sure whether the medications had been given. Review of the 12/01 medication record for the same record showed resident was prescribed Catapres Patch, once a week and was due 12/12/01. The medication had been charted as given 12/14/01. Risperdal was out the morning of 12/20/01 and had not been given. Blood Pressure twice weekly had last been done 12/14/01 and was due 12/18/01, but had not been charted as done according to the med log. Staff took the blood pressure the day of the visit when the problem was noted. 19. Respondent was provided a mandated correction date of December 20, 2001. 20. On or about March 20, 2002, a follow-up survey was conducted at the Respondent’s facility. At this survey, the deficiency remained uncorrected. 21. Based on record review and staff interview, Respondent failed to maintain an up-to-date medication observation record for three of five sampled residents. The findings include: Medication and medication observation record (MOR} revealed: 1. Resident is to get blood sugar testing before breakfast, and receives Novolin R100 insulin per sliding scale orders. MOR documentation is as follows: 3/2 blood sugar (BS) and insulin administration not documented as done/given, nor was other notations to explain the omission. On 3/11- BS=221, per scale resident should have received 30U of Novolin R 100 and 3/13-BS=233, again per scale resident should have received 50U of Novolin R 100. Documentation was not available to validate the administration of insulin. 2. MOR reads Zestril 10mg one daily- medication bottle reads Zestril 40mg take 1/2 tab daily. The pills are not scored, observations noted that the pills in the bottle were cut in small uneven pieces. Staff stated that the pills get cut in fourths, in an attempt for the resident to receivel0mg, as the facility is under the assumption that 10mg is the correct dosage. DON stated that medications come from the VA pharmacy, and is dispensed in 40 mg, but MOR reads 10mg. No written documentation was available to verify correct dosage. 3. MOR reads Uniphyl 400mg one daily- omissions on MOR for 3/16, 3/17 and 3/18, no written documentation was available to explain the reasons for the omissions. 22. The above actions or inactions are a violation of Rule 58A-5.0185(5) (b), Florida Administrative Code, which requires the facility to maintain a daily up-to-date medication observation record (MOR) for each resident who receives assistance with self-administration or medication administration. A MOR must include the name of the resident and any known allergies the resident may have; the name of the resident’s health care provider, the health care provider’s telephone number; the name of each medication prescribed, its strength, and directions for use; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The MOR must be immediately updated each time the medication is offered or administered. 23. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (c), Florida Statutes, the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). 24. Pursuant to Section 400.419(9), Florida Statutes, AHCA is authorized to, in addition to any administrative fines, assess a survey fee equal to the lesser of one-half of the facility’s biennial license and bed fee, or $500, to cover the cost of conducting the initial complaint investigations that result in the finding of a violation that was the subject of the complaint, or for monitoring visits conducted under 400.428(3) (c) to verify the correction of the violations. SECOND UNCORRECTED CLASS III DEFICIENCY 25. On or about June 19, 2002, a second follow-up survey was conducted at Respondent’s facility. At this time, the above-listed deficiency remained uncorrected. 26. Based on record review, the Respondent failed to maintain an up-to-date medication observation record (MOR) for one of five sampled residents. The findings include: MOR and medication review on 6/19/02 for sampled resident # 2 revealed a bubble pack dated "3/30/03 Ferrous Sulfate one daily". MOR dated 6/1 thru 6/30 does not list Ferrous Sulfate as one of the resident's current meds. Per staff, resident returned from the hospital 4/18/02 and staff thought the medication had been d/c. Record review revealed physician's order dated 4/18/02, order calls for Ferrous Sulfate -one daily. 27. Respondent was provided a mandated correction date of June 20, 2002. 28. The above actions or inactions are a violation of Rule 58A-5.0185(5) (b), Florida Administrative Code, which requires the facility to maintain a daily up-to-date medication observation record (MOR) for each resident who receives assistance with self-administration or medication administration. A MOR must include the name of the resident and any known allergies the resident may have; the name of the resident’s health care provider, the health care provider's telephone number; the name of each medication prescribed, its strength, and directions for use; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The MOR must be immediately updated each time the medication is offered or administered. 29. Said violation constitutes the grounds for the imposed second uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1)(c), Florida Statutes, the Agency is authorized to impose a fine in the amount of seven hundred fifty dollars ($750). THIRD UNCORRECTED CLASS III DEFICIENCY 30. On or about November 14, 2002, a survey was conducted at Respondent’s facility. 31. Respondent failed to maintain an updated medication observation record (MOR) for seven of twelve random sampled residents. The findings include: Random medication cart (4) and Medication Observation Record (MOR) review revealed: House 200 (the secure unit) consisting of 2 floors and 2 med carts: None of the medications due on 11/14/02 am were marked as given for residents who reside in the secure unit. The nurse stated that she passed all the meds but did not make entries on the MOR. The following medications were not marked as given on 11/11/02 Resident #1: Aspirin 325mg once daily, Paxil 20mg once daily, Synthroid 50mcg once daily, Exelon 3mg twice daily and Sotalol 120mg twice daily Resident # 2: Rantidine 150mg twice daily not marked as given 11/5/02 Resident #3: MOR reads Oyst -Cal 500mg one three times a day- Rx (prescription) dated 8/29/02 calls for one tab. twice daily Resident #4: MOR reads Depakote 500mg -2 tabs at bedtime, Rx 11/7/02 calls for 1 tab. twice daily, Thioridazine 25mg two tabs at bedtime -Fluocinonide 0.005% solution apply to scalp daily not marked as given on 11/7 and 11/13/02 and Donovex 0.005% apply daily to patchy abrasion on skin, marked as given on 11/13/02 Resident # 5: the following daily meds not marked as given on 11/11/02: Premarin 1.25mg, Aspirin 325mg, Diltiazem HCL 180mg, Plavix 75mg, Furosemide 40mg, Amitriptyline HCL 50mg and KCL 20mg House 300: Resident # 6: Glucophage 500mg twice daily; not marked as given 11/8/02 Resident # 7: Ferrous Sulfate 325mg; not marked as given on 11/13/02 No written notations are available to document the reason for the omissions on the MOR. The nurses stated that they have not had the opportunity to update the MOR. 32. The above actions or inactions are a violation of Rule 58A-5.0185(5) (b), Florida Administrative Code, which requires the facility to maintain a daily up-to-date medication observation record (MOR) for each resident who receives assistance with self-administration or medication administration. A MOR must include the name of the resident and any known allergies the resident may have; the name of the resident’s health care provider, the health care provider's telephone number; the name of each medication prescribed, its strength, and directions for use; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The MOR must be immediately updated each time the medication is offered or administered. 33. Said violation constitutes the grounds for the imposed second uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (ce), Florida Statutes, the Agency is authorized to impose a fine in the amount of one thousand dollars ($1,000). COUNT II RESPONDENT FAILED TO ENSURE THAT PRESCRIPTION DRUGS KEPT BY THE FACILITY ARE PROPERLY LABELED AND DISPENSED IN VIOLATION OF Fla. Admin. Code R.58A-5.0185(7) (a) (2002) FIRST UNCORRECTED CLASS III DEFICIENCY 34. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 35. On or about March 20, 2002, a survey was conducted at Respondent’s facility. 36. Based on observation and interview, Respondent failed to ensure that no prescription drugs are kept in the facility unless properly labeled and dispensed per regulations. The findings include: MOR for resident reads Paxil 20mg, on hand. The facility had Paxil 20mg -samples. Also among resident's meds were samples of Zyprexa 2.5 mg , MOR reads Zyprexa 2.5 mg at bedtime. The samples were not labeled, nor was there a physician's order for use. Staff stated that physician had given samples to resident's daughter to bring to the facility for resident's use. 37. Respondent was provided an immediate mandated correction date of March 20, 2002. 38. On or about June 19, 2002, a follow-up survey was conducted at Respondent’s facility. At this survey, the deficiency remained uncorrected. 39. Based on observation and interview, Respondent failed to ensure that no prescription drugs are kept in the facility unless properly labeled and dispensed per regulations. The findings include: During a random medication review of the secure unit medication cart, the following unlabeled prescription medications were found: Bactroban ointment , Bactrim Zinc ointment, AmLactrim 12% lotion (had resident's name written on bottle). DON stated that she was not aware that those meds were there as facility does not keep stock meds. The nurse and DON both agreed that these meds are prescription medications. 40. Respondent was provided a mandated correction date of June 20, 2002. 41. The above actions or inactions are a violation of Rule 58A-5.0185(7) (a), Florida Administrative Code, which provides that no prescription drug shall be kept by the facility unless it is properly labeled and dispensed in accordance with Chapters 465 and 499, F.S. 42. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1)(c), Florida Statutes, the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). SECOND UNCORRECTED CLASS III DEFICIENCY 43. On or about November 14, 2002, a survey was conducted at Respondent’s facility. 44. Based on observation, medication review and interview, Respondent failed to ensure that no prescription drug is kept in the facility unless properly labeled and dispensed per regulations in three of seventy-six medications reviewed (4 medication carts). The findings include: During a random medication review of the 100 and 400 building medication cart, the following prescription medications were found unlabelled: 2 bottles of Zocor 80 mg (7 tabs. in each), Miacalcin Nasal Spay and Remeron 15 mg. Nurse stated that residents bring the samples from the doctor's office. As for the Miacalcin, the box which contained the prescription was thrown away because it took up too much space in the medication compartment. 45. The above actions or inactions are a violation of Rule 58A-5.0185(7) (a), Florida Administrative Code, which provides that no prescription drug shall be kept by the facility unless it is properly labeled and dispensed in accordance with Chapters 465 and 499, F.S. 46. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (c), Florida Statutes, the Agency is authorized to impose a fine in the amount of one thousand dollars ($1,000). COUNT III RESPONDENT FAILED TO PROVIDE THE AGENCY WITH, AT A MINIMUM, QUARTERLY ON-SITE CORRECTIVE ACTION PLAN UPDATES IN VIOLATION OF Fla. Admin. Code R.58A-5.033(4) (a) (3) (2002) FIRST UNCORRECTED CLASS III DEFICIENCY 47. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 48. On or about March 20, 2002, a survey was conducted at Respondent’s facility. 49. Respondent was required to ensure that a plan of corrective action was developed, implemented and submitted to the AHCA area office, as per regulations. The findings include: The facility has three Class III uncorrected deficiency relating to facility medication practice. Please develop and implement a plan of corrective action to remedy the medication practice/ errors. The initial on-site visit must take place within 7 working days of the identification of a class I or class II deficiency and within 14 working days of the identification of an uncorrected class III deficiency. 50. Respondent was provided a mandated correction date of April 4, 2002. 51. On or about June 19, 2002, a survey was conducted at Respondent’s facility. At this survey, the above-listed requirement remained was not completed. 52. Respondent was provided a mandated correction date of July 11, 2002. 53. On or about November 14, 2002, a survey was conducted at Respondent’s facility. 54. Based on interview and medication review, Respondent failed to ensure that a plan of corrective action was developed, implemented and submitted to the AHCA area office, as per regulations. The findings include: The facility has two (2) Class III uncorrected deficiencies relating to facility medication practice. A plan of corrective action to remedy the medication practice/errors is required to be developed by a nurse (RN) consultant or a pharmacist no later than 14 working days after the identification of an uncorrected Class III deficiency. 55. The above actions or inactions are a violation of Rule 58A-5.033 (4) (a) (3), Florida Administrative Code, which requires the facility to provide the Agency with, at a minimum, quarterly on-site corrective action plan updates until the Agency determines after written notification by the consultant and facility administrator that deficiencies are corrected and staff has been trained to ensure that proper medication standards are followed and that such consultant services are no longer required. 56. Said violation constitutes the grounds for the imposed uncorrected Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1)(c), Florida Statutes, the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration requests the Court to order the following: 1. Make factual and legal findings in favor of the the Agency on Count I, Count II and Count IIT; 2. Impose a fine in the amount of five thousand two hundred and fifty dollars ($5,250) for the violations cited in Count I, Count II and Count III against the Respondent, pursuant to Sections 400.419(1)(c) and 400.419(9), Florida Statutes; and 3. Any other general and equitable relief as deemed appropriate. The Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the attention of Katrina D. Lacy, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr. N., #330G, St. Petersburg, Florida, 33701. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, 6) Pp Lptlicws LP. datrina D. Lacy, Esqujre AHCA - Senior Attorney Fla. Bar No. 0277400 525 Mirror Lake Drive North, St. Petersburg, Florida 33701 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished via U.S. Certified Mail Return Receipt No. 7002 2030 0007 8499 6003 to Corporation Service Company, Registered Agent for Stanford Centre, Inc., 1201 Hays Street, Tallahassee, FL 32301 on March 4 , 2003. flat D> ficey ire Katrina D. Lacy, Es Copies furnished to: Corporation Service Company Resident Agent for Stanford Centre, Inc. 1201 Hays Street Tallahassee, FL 32301 (Certified U.S. Mail) Susan L. Nero, Administrator Stanford Centre, Inc. 433 Orange Drive Altamonte Springs, FL 32701 (U.S. Mail) Katrina D. Lacy AHCA - Senior Attorney 525 Mirror Lake Drive Suite 330G St. Petersburg, Fl 33701

Docket for Case No: 03-001365