‘ STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 4p 4 te! Cp At} Gh) AGENCY FOR HEALTH CARE “4, ADMINISTRATION, Petitioner, vs. Case No. 2004005088 THE APPLE HOUSE, INC., a a -OTI5 Respondent. / * ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), .by, and through the undersigned counsel, and files this Administrative Complaint against THE APPLE HOUSE, INC., hereinafter referred to as. “Respondent,” pursuant to Sections 120.569 and 120.57, Florida Statutes (2003), and alleges: NATURE OF THE ACTION 1. This is-an action to impose an administrative fine in the amount of $1,000.00, against the’ Respondent, pursuant to Sections 400.414, 400.419(1)(b), and ’ 400.419(9), Florida Statutes (2003); and Rule 58A-5.0185(4)(a), Florida Administrative Code (2003). 2. The Respondent was cited for a Class II violation during an unannounced monitoring visit AHCA conducted on or about April 4, 2004. The violation cited constituted an uncorrected Class II violation from the follow-up to the unannounced monitoring visit AHCA completed on April 29, 2004. JURISDICTION AND VENUE INE eee 3. This tribunal has jurisdiction over the Respondent, pursuant to Sections 120.569 and 120.57, Florida Statutes (2003). . 4. Venue shall be determined, pursuant to Chapter 28-106.207, Florida Administrative Code (2003). PARTIES 5. Pursuant to Chapter 400, Part III, Florida Statutes (2003), and Chapter 4 58A-5, Florida Administrative Code (2003), AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules. 6. The Respondent is an assisted living facility located at 422 Pleasant Street, Pomona Park, Florida 32181. The Respondent is and was at all times material hereto a licensed facility under Chapter 400, Part II, Florida Statutes (2003), and Chapter 58A-5, _ Florida Administrative Code (2003), having been issued license number 8345. COUNTI The Respondent failed to ensure that residents received their medications according to physician’s orders. § 400.414, Fla. Stat. (2003) § 400.419(1)(b), Fla. St 00 Fla. Admin. Code R. 58A-5.0185(4)(a) (2003) 7. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through five (6) as if fully set forth herein. 8. On or about April 4, 2004, AHCA conducted an unannounced monitoring visit at the Respondent's facility. AHCA cited the Respondent for a violation, based on the findings below, to wit: On 3/30/04 review of the record revealed resident #8 documented that the resident was tc receive Coumadin (an anticoagulant medication), 5 mg daily Monday thru Friday and 7.5 mg daily on Saturdays and Sundays. Review of the Marck 2004 MOR [Medication Observation Record] revealed the resident a) Page 2 of 8 received Smg and 7.5mg (12.5 mg) on Monday, 3/1/04 and on Monday and Tuesday, 3/8/04 and 3/9/04. Interview with staff at approximately 1:30PM revealed they were not aware of the medication error until it was brought to their attention. b) During review of the MOR [Medication Observation Record] with the License Practical Nurse (LPN), at approximately 1:15 PM on 3/31/04, it was revealed that resident #5 did not receive his/her Keflex (antibiotic) 500 milligram (mg) at 9 AM this morning. The LPN stated that the resident did not take this medication because he/she was only on it for 10 days and that the 10 days were done. Further review of the MOR revealed that the resident had been on the antibiotics for 9 days and that 3/31/04 was the 10th day. The LPN stated that she had missed the morning dosage, but would give the next dosage at its scheduled time (1 PM). 9. The Respondent failed to ensure that residents received their medications according to physician’s orders, as required by Fla. Admin. Code R. 58A-5.0185(4)(a) (2003). ‘ 10. | The appropriate administration of medications to residents of assisted living units, is required as follows: : “(4) MEDICATION ADMINISTRATION. (a) For facilities which provide medication administration a staff member, who is licensed to administer medications, must be available to administer medications in accordance with a health care provider’s order or prescription label. An assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility.” (Fla. Admin. Code R. 58A-5.0185(4)(a) (2003)) 11. For this violation, AHCA provided the Respondent a mandated correction date of April 5, 2004. 12. The foregoing violation constitutes a Class II violation, due to the nature of the violation and the gravity of its probable effect on the residents of the facility, to wit: “(b) Class “II” 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 I violations. A class H] violation is subject to an administrative fine in an amount not less than $1,000 and not exceeding $5,000 for each violation...” (§ 400.419(1)(b), Fla. Stat. (2003)) 13. On April 29, 2004, AHCA conducted a follow-up to the unannounced monitoring visit at the Respondent’s facility. AHCA cited the Respondent for an uncorrected violation, based on the findings below, to wit: a) Review of the MOR [Medication Observation Record} for Resident #5 on 4/29/04 with facility staff at approximately 11:30am revealed the resident was ordered to be given Fioricet 1 tablet three times per day at 9:00am, 1:00pm and 5:00pm. Further review revealed the dose for 1:00pm had already been signed off as being given. b) Review of the MOR [Medication Observation Record] for Resident #6 on 4/29/04 with facility staff at approximately 11:30am revealed the resident was ordered to have Ultram 50mg and Dipyridamole 50mg four times per day at 9:00am, 1:00pm, 5:00pm and 8:00pm. Further review revealed the dose for 1:00pm had already been signed off as being given. c) Review of the MOR [Medication Observation Record] for Resident #14 on 4/29/04 with facility staff at approximately 11:30am revealed the resident was ordered to have Reglan 10mg three times per day at 9:00am, 1:00pm and 5:00pm. Further review revealed the dose for 1:00pm had already been signed off as being given. Mt d) Interview with facility staff at 12:45pm revealed they had’ just received a telephone call from the LPN who stated she gave the 1:00pm doses to the above residents thinking they were to be given at 12:00pm. 14. _ The foregoing violation constitutes an uncorrected Class II violation, due to the nature of the violation and the gravity of its effect on the residents of the facility and warrants a fine of $1,000.00, to wit: “(b) Class “II” violations are those conditions or occurrences related to the-eperation- 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 I violations. A class 1] violation is subject to an administrative fine in an amount not less than $1,000 and not exceeding $5,000 for each violation...” (§ 400.419(1)(b), Fla. Stat. (2003)) 15. | AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the uncorrected actions of the administrator, the financial benefit to the facility of committing or continuing the violation, and the licensed capacity of the facility. WHEREFORE, AHCA demands the following relief: Page 4 0f&§ 1. Enter factual and legal findings as set forth in the allegations of this count; 2. Impose a fine in the amount of $1,000.00, for the referenced violation; 3. And such other appropriate relief as this tribunal may find and deem appropriate. NOTICE The Respondent, THE APPLE HOUSE, INC., 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 Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made-to the Agency for Health Care Administration, and delivered to the Agency for Health "Care Administration, 2727 Mahan Dr., Bldg. 3, MSC 3,Tallahassee, Florida, 32308; Attention: Agency Clerk. THE RESPONDENT IS FURTHER NOTIFIED, IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION: WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. — cay . Submitted on this at day of eet 2004, Etic R. Bredemeyer, Senior Attorney’ Fla. Bar No. 318442 Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, MSC #3 Tallahassee, FL 323068 Phone: (850) 922-5873 Fax: (850) 921-0158 CERTIFICATE OF SERVICE ' I HEREBY CERTIFY that the original Administrative Complaint, Explanation of Rights form, and Election of Rights forms have been sent by U.S. Certified Mail, Retum Receipt Requested, to The Apple House, Inc., Attention: Administrator, 422 Pleasant Street, Pomona Park, Florida 32181; and a copy of the forgoing Administrative Complaint has also been sent by USS. Mail to Robert Pritchard, Esquire, 1301 Riverplace Blvd., Suite 1500, Jacksonville, Florida 32207. —T ° Submitted on this @> dayof___ J wn 2004, Eric R. Bredemeyer, Senior Attomey e 6 of § as) iy 7

Docket for Case No: 04-002715