STATE OF FLORIDA LE AGENCY FOR HEALTH CARE ADMINISTRATIQN 4. ~ td NT Pit Gs 9g STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Case No. 2004001689 vs. GULF COAST JEWISH FAMILY a » - | OK SERVICES, INC., d/b/a GULF COAST JEWISH FAMILY SERVICES/HACIENDA HOME, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter the “Agency”), by and through the undersigned counsel. and files this Administrative Complaint against GULF COAST JEWISH FAMILY SERVICES, INC., d/b/a GULF COAST JEWISH FAMILY SERVICES/HACIENDA HOME (hereinafter “Gulf Coast”), pursuant to §§ 120.569 and 120.57, Fla. Stat. (2003), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of $1,000.00 per day against Gulf Coast, pursuant to Section 394.879(4), Fla. Stat. (2003), based upon two cited State deficiencies as set forth below. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.569, 120.57, and 394.879(4) Fla. Stat. (2003). 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207 (2003). PARTIES 3. The Agency is the regulatory authority responsible for licensure of Residential Treatment Facilities and enforcement of all applicable federal regulations, state statutes and rules governing Residential Treatment Facilities pursuant to Chapter 394, Florida Statutes (2003) and Rules 65E-4, Florida Administrative Code (2003). 4. Gulf Coast operates a 75-bed Residential Treatment Facility located at 5621 Main Street, New Port Richey, Pasco County, Florida 34652, and is licensed as a Level 1B Residential Treatment Facility under license number 448. 5. Gulf Coast was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Pursuant to Florida law, direct service staff shall report resident illnesses and significant physical dysfunctions in a timely manner to the resident’s or organization's physician and note such in the resident’s record. Fla. Admin. Code R. 65E-4.016(12)(e)3. 8. On or about February 5, 2004, Agency representatives conducted a complaint investigation (Complaint Investigation # 2004-001005) at Gulf Coast. 9. Based upon review of Gulf Coast’s facility records and staff interviews. the Agency determined that Gulf Coast failed to ensure that direct service staff reported resident illness and significant physical dysfunctions in a timely manner to the resident's or organization's physician and note such in the resident's record for one (Resident # 1) out of eleven sampled residents. 10. Resident # 1, whose diagnoses included chronic paranoid schizophrenia, severe hypertension, and history of renal insufficiency secondary to dehydration, was admitted to Gulf Coast on or about 09/30/03 following a hospital admission. 11. The day after Resident # 1’s admission to Gulf Coast, on 10/01/03, a psychiatrist performed a psychiatric evaluation on Resident # 1. According to the evaluation, Resident # 1 was not, at that time, expressing any phobias, obsessions, or delusions and he/she denied auditory and visual hallucinations. 12. The psychiatrist documented the following under “Treatment Recommendations/Medication Orders” in his evaluation: “The nursing staff members of this facility will monitor his/her medication intake”. 13. Onor about 10/02/03, Resident # 1 had a history and physical performed by an Advanced Registered Nurse Practitioner (“ARNP”). The history and physical documented that Resident # 1 had a history of severe hypertension and his/her blood pressure on that day was documented as 160/82. 14. Agency representatives reviewed Resident # 1’s medication administration records (“MARS”). 15. According to the resident’s MARS and other records, Resident #1 had physician’s orders for four antihypertensive medications to control his/her blood pressure. The medications included: Clonidine Hydrochloride 0.3mg, 1 by mouth (“PO”) three times per day (“TID”), Lopressor (Metoprolol) 100mg, | PO two times per day (“BID”); Norvasc 10 mg, 1 PO every day (“QD”), and; Prinivil (Lisinopril) 40 mg, 1 PO BID. 16. The resident had been taking these medications prior to his/her admission to the facility and continued to have orders for these medications throughout his/her residency, which ended on January 5, 2004, when the resident expired. 17. According to the MARS, starting on December 12, 2004, Resident # 1 consistently started refusing to take his/her blood pressure medications. 18. According to the MARS, starting on and following December 12, 2004 and until the resident’s death on January 5, 2004, the resident missed 167 doses of his/her prescribed antihypertensive medications. 19. Gulf Coast staff members circled their initials for the aforementioned 167 doses of medication on the MARS, indicating that the resident did not take the medication. 20. On the back of the MARS, the staff members documented that the resident refused the medications. However, the staff members only documented the reason for the refusal one (1) time. On this particular day and time, 12/28/04 at 7:00 a.m., the staff member documented, “Ref. circled meds”, then documented “I feel my soul leaving my body” (which indicated that the resident had made this comment). 21. Agency representatives reviewed the Progress Notes for this resident. 22. Gulf Coast staff members had only documented one (1) time in the Progress Notes that the resident had refused his/her medications. 23. The aforementioned documentation was dated 01/05/04, the date of the resident’s death, at 6 p (6:00 p.m.). The Progress Note stated that the resident had refused his medications at 4:30 p.m., however, again, no reason was given. 24. There was no documentation in Gulf Coast’s records on this date, or on any other date, that Gulf Coast staff had called the resident’s physician or the organization’s physician to report that the resident was refusing to take his/her antihypertensive medications. 25. There is also no documentation in Gulf Coast’s records that the staff members took this resident’s blood pressure. In the Progress Note dated 01/05/04 at 6:00 p.m., which referred to the 4:30 p.m. medication refusal, the staff member documented, “I asked him/her if he/she would let us take his/her BP and he/she also refused this." 26. Other than the aforementioned documentation on 01/05/04, the date of the resident’s death, no other documentation was found in Gulf Coast’s records which indicated that staff had ever attempted to check this resident’s blood pressure. 27. Other changes in Resident # 1’s condition were noted in the resident’s Progress Notes. 28. On 12/07/03 at 10:15 p.m., staff documented in the resident’s Progress Notes that the resident stated, “...Something in my room is making me angry.” 29. On 12/0803 at 3:40 p.m., staff documented in the resident’s Progress Notes that the resident’s “{O]utbursts have increased the past week.....At med pass time, if more than “good morning” is said to him, (the resident) escalates and begins (unreadable) and threatening. He mumbles continuously while getting his meds — if asked whether he is speaking to this writer, he will escalate and begin yelling. (The resident) sees Consult Care for his medical issues...” 30. On 12/21/03 and 01/04/03, staff documented in the resident’s Progress Notes that the resident was compliant with his medications; however, he/she had refused his/her antihypertensive medications consistently since 12/12/03. 31. There was no documentation present in Gulf Coast’s records which indicated that the staff had contacted the resident’s or organization’s physician to report the resident’s change in condition evidenced by his/her change in behavior and his/her refusal to take his/her antihypertensive medications. 32. At approximately 2 hours and 15 minutes after the first documented information in the Progress Notes concerning the resident’s refusal of his/her blood pressure medication, at around 8:15 p.m. on 01/05/04, Resident # 1 was found unresponsive in his/her room. 33. Gulf Coast staff called 911 and initiated CPR. Staff documented that the Emergency Medical Technicians (“EMTs” ) arrived and took over treatment of the resident. They further documented that the EMTs were unable to get a heartbeat, indicating that the resident had expired. 34, During the complaint investigation, on 02/05/04, Agency representatives interviewed the Clinical Director and the Administrative Assistant. Neither of these employees had knowledge as to whether the resident’s or organization’s physician was ever contacted to report the resident’s change in behavior and refusal to take 167 doses of his/her antihypertensive medications. 35. The aforementioned changes in Resident # 1’s condition were signs and symptoms of illness and significant physical dysfunction. 36. Florida law requires Residential Treatment Facilities’ direct service staff to report illnesses and significant physical dysfunctions in a timely manner to the resident’s or organization’s physician and note such in the resident’s record. 37. Gulf Coast’s direct service staff failed to report resident illnesses and significant physical dysfunctions in a timely manner to the resident’s or organization’s physician and note such in the resident’s record, therefore violating Fla. Admin. Code R. 65E-4.016(12)(e)3. 38. | The Agency has determined that the above-referenced violations constitute the grounds for the imposed deficiency, and for which a fine of $500.00 per day is authorized pursuant to § 394.879(4), Fla. Stat. (2003). 39. The Agency provided Gulf Coast with a mandated correction date of February 8, 2004. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,500.00, or such other amount as determined by the Court based upon the evidence, against Gulf Coast, a licensed Residential Treatment Facility in the State of Florida, pursuant to Section 394.879(4), Fla. Stat. COUNT It 40. The Agency re-alleges and incorporates paragraphs (1) through (5) and paragraphs (7) through (39) as if fully set forth herein. 41. Pursuant to Florida law, the legal and civil rights of residents shall be safeguarded. Residential Treatment Facilities shall be administered in a manner that protects the resident’s rights, life and physical safety. Fla. Admin. Code R. 65E-4.016(14)(b). 42. Pursuant to Florida law, Residential Treatment Facilities shall have or be part of an established quality assurance program with written policies and procedures that include the following...Minimum therapeutic dosages of medication are prescribed and appropriately administered. Fla. Admin. Code R. 65E-4.016(a)(1)(g). 43. On or about February 5, 2004, Agency representatives conducted a complaint investigation (Complaint Investigation # 2004-001005) at Gulf Coast. 44. Based upon review of Gulf Coast’s facility records and staff interviews, the Agency determined that Gulf Coast failed to provide administrative oversight in a manner that protected the life and physical safety of one out of eleven (Resident # 1) sampled residents. 45. During the complaint investigation, Agency representatives interviewed Gulf Coast’s Clinical Director and the Administrative Assistant. 46. Neither of these staff members were aware if Resident # 1’s physician had been notified that he/she was refusing his/her antihypertensive medications prior to the date of Resident # 1’s death, on 01/05/04. 47. According to the administration, staff members had not informed them that Resident # 1 had been refusing his/her antihypertensive medications. 48. Gulf Coast failed to have a policy and procedure in place prior to Resident # 1’s demise which required staff members to contact a resident’s physician when a resident refuses to take his/her medications. 49. Gulf Coast also failed to have a policy and procedure in place which required staff members to communicate and report resident medication refusals between staff during the change of shifts and between staff members, their supervisors, and the administration. 50. Florida law requires Residential Treatment Facilities to implement written policies and procedures which ensure that minimum therapeutic dosages of medications are appropriately administered. 51. The administration of Gulf Coast failed to implement such policies and procedures, therefore violating Fla. Admin. Code R. 65E-4.016(a)(1)(g). 52. By failing to implement policies and procedures which ensured that residents’ minimum therapeutic dosages of medication were appropriately administered, Gulf Coast failed to protect the rights, life and physical safety of is residents in violation of Fla. Admin. Code R. 65E-4.016(14)(b). 53. | The Agency has determined that the above-referenced violations constitute the grounds for the imposed deficiency, and for which a fine of $500.00 per day is authorized pursuant to § 394.879(4), Fla. Stat. (2003). 54. The Agency provided Gulf Coast with a mandated correction date of February 8, 2004. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,500.00, or such other amount as determined by the Court based upon the evidence, against Gulf Coast, a licensed Residential Treatment Facility in the State of Florida, pursuant to Section 394.879(4), Fla. Stat. Respectfully submitted this Q ) “day of February 2005. Bumbo . mT 7 Senior Attorney Fla. Bar. No. 571628 Agency for Health Care Administration 525 Mirror Lake Drive, 330D St. Petersburg, FL 33701 727/ 552-1435 (office) The Remainder of This Page Intentionally Left Blank 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 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 Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, Florida, 32308. 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. CERTIFICATE OF SERVICE J HEREBY CERTIFY that a true and correct copy of the foregoing has been served by USS. Certified Mail, Return Receipt No. 7003 1010 0002 4667 1538 on this the Aotday of February, 2005 to: Michael Bernstein, Registered Agent, Gulf Coast Jewish Family Services/Hacienda Home, 14041 Icot Boulevard, Clearwater, Florida 33760 and by U.S. Mail to: Michael Bernstein, Administrator, Gulf Coast Jewish Family Services/Hacienda Home, 5621 Main Street, New Port Richey, Florida 34652. fernburly PL : i ” Copies furnished to: Michael Bernstein Michael Bernstein Kimberly M. Murray Registered Agent Administrator Agency for Health Care Gulf Coast Jewish Family Gulf Coast Jewish Family Administration Services/Hacienda Home Services/Hacienda Home 525 Mirror Lake Drive, 330D 14041 Icot Boulevard 5621 Main Street St. Petersburg, Florida 33701 Clearwater, Florida 33760 New Port Richey, Florida 34652 | (Interoffice) (U.S. Certified Mail) L@U.S. Mail) 10 PAYMENT FORM Agency for Health Care Administration Finance & Accounting Post Office Box 13749 Tallahassee, Florida 32317-3749 Enclosed please find Check No. in the amount of $ , which represents payment of the Administrative Fine imposed by AHCA. Gulf Coast Jewish Family Services / Hacienda Home Facility Name 2004001689 AHCA Case No.

Docket for Case No: 05-001308