. . . , On SAS3 a> oy f iy “é€ lo, STATE OF FLORIDA ; AGENCY FOR HEALTH CARE ADMINISTRATION Tf) “Oy g Casipia, Be STATE OF FLORIDA, “Ufa AGENCY FOR HEALTH CARE ‘ : oe ADMINISTRATION, Petitioner, ; ; vs. : Case Nos. 2007009922 (Fine) 2007009923 (CL) HARBOUR HEALTH SYSTEMS, LLC d/b/a HARBOUR HEALTH CENTER, Respondent. ; ADMINISTRATIVE COMPLAINT ; ‘COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against HARBOUR HEALTH SYSTEMS, LLC d/b/a HARBOUR HEALTH CENTER (hereinafter “Respondent”), pursuant to Sections 120.569 and 120.57 Florida Statutes (2007), and alleges: NATURE OF THE ACTION This is an action against a skilled nursing facility to impose an administrative fine of ONE THOUSAND DOLLARS ($1,000.00) pursuant to Section 400.23(8)(c), Florida Statutes (2007), based upon one uncorrected Class Ill deficiency and assign conditional licensure status beginning _on July 19, 2007, and ending on August 23, 2007, pursuant to Section 400.23(7)(b), Florida Statutes (2007). The original certificate for the conditional license is attached as Exhibit A and is incorporated by reference. The original certificate for the standard license is attached as Exhibit B and is incorporated by reference. JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2007). 2. The Agency has jurisdiction over the Respondent pursuant to Section 20.42, Chapter 120, and Chapter 400, Part Il, Florida Statutes (2007). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code (2007). PARTIES 4. The Agency is the regulatory authority responsible for the licensure of skilled nursing facilities and the enforcement of all applicable federal and state statutes, regulations and rules governing skilled nursing facilities pursuant to Chapter 400, Part I, Florida Statutes (2007) and Chapter 59A-4, Florida Administrative Code (2007). The Agency is authorized to deny, suspend, or revoke a license, and impose administrative fines pursuant to Sections 400.121, and 400.23, | . Florida Statutes (2007); assign a conditional license pursuant to Section 400.23(7), Florida Statutes (2007); and assess costs related to the investigation and prosecution of this case pursuant to Section 400.121, Florida Statutes (2007). 5. Respondent operates a 120-bed nursing home, located at 23013 Westchester Boulevard, Port Charlotte, Florida 33980, and is licensed as a skilled nursing facility, license number 1504096. 6. Respondent was at all times material hereto, a licensed skilled nursing facility under the licensing authority of the Agency, and was required to comply with all applicable state rules, regulations and statutes. COUNTI The Respondent Failed To Follow Physician Orders In Violation Of Rule 59A-4.107(5), Florida Administrative Code (2007) 7. The Agency re-alleges and incorporates by reference paragraphs one (1) through six (6). 8. Pursuant to Florida law, all physician orders shall be followed as prescribed, and if not followed, the reason shall be recorded on the resident’s medical record during that shift. Rule 59A- 4.107(5), Florida Administrative Code (2007). 9. Onor about June 4, 2007 through June 7, 2007 the Agency conducted an Annual Survey of Respondent’s facility. 10. Based on record review, observations, and interview, it was determined the facility failed to ensure the nursing services provided by the facility met professional standards of quality of care for three (3) of twenty (20) active sampled residents, Resident number two (2), Resident number seven (7), and Resident number eighteen (18). This is evident by the facility not following physician orders. Not following physician orders has the potential for negative resident outcomes. 11. Areview of the medical record for Resident number two (2) revealed a physician's order dated May 15, 2007 for the nurses to obtain three (3) stool specimens, then administer Cipro (an antibiotic) twice a day for seven (7) days. A review of the medication administration record revealed the resident was administered the seven (7) days of Cipro without first obtaining the stool specimens as ordered by the physician. A further review of the nurses notes reveals the physician was never notified of this error. 12. An interview with the Assistant Director of Nursing on June 4, 2007 validated the stool _ specimens were never obtained before the Cipro was administered. 13. | A review of the medical record for Resident number eighteen (18) revealed a physician order dated May 31, 2007 instructed the Social Services Department to review the Living Will and address hydration and nutrition issues. The medical record indicated the resident was declining in health and continuing to lose weight. The order was acknowledged by the nurse on June 1, 2007. 14, An interview with the Director of Social Services on June 6, 2007 in the afternoon validated this was not done and she was unaware of the physician’s order. 15. A further review of the medical record for Resident number eighteen (18) revealed a physician’s order dated February 8, 2007 instructing the nursing staff to apply thigh high compression stockings every morning and remove every evening. 16. | Anobservation of Resident number eighteen (18) on June 6, 2007 in the morning and again in the afternoon revealed the stockings had not been applied. 17. Aninterview with the direct care staff revealed the stockings had not been applied for ; awhile and staff was unable to readily locate the stockings. 18. Aninterview with Resident number eighteen (18) on June 6, 2007 revealed the staff had not put the stockings on the resident since he/she had become bed bound. Compression stockings are applied to mostly bedfast residents to promote circulation, prevent swelling in the feet and legs, and prevent blood clots. The resident is in the advanced stages of-cardiac disense and is in bed most of the time. 19. A review of the treatment sheets for May, 2007 and June, 2007 reveal the nurses had documented the stockings had been applied and removed twenty-two (22) out of thirty-seven (37) days. 20. A review of Resident number seven’s (7) medical record on June 5, 2007 revealed a physician's progress note dated May 3, 2007 discontinuing the medication Aricept. Further, the physician's telephone orders revealed a phone order taken by the nurse documenting to discontinue Aricept. A review of the facility’s medication administration record for May 2007 reveals Aricept 10 mg was continued for the whole month; a review of June 2007 medication administration records reveals Aricept 10 mg was given on June 1, 2007; June 2, 2007; June 3, 2007, and June 4, 2007, until surveyor intervention. 21. Aninterview with the Director of Nursing on June 5, 2007 at 12:00 p.m. revealed she was, not able to find a restart medication order. She stated she would call and notify the physician of the missed order. 22, | The Agency determined that this deficient practice will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident's ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and . provision of services. The Agency cited the Respondent for a Class II deficiency as set forth in Section 400. 23(8)(c), Florida Statutes (2007). 23. The Respondent was given a mandatory correction date of July 7, 2007. 24. Onor about July 18, 2007 through July 19, 2007 the Agency conducted a follow-up visit to the Annual Survey of the Respondent s facility. 25. Based on record review and interview, it was determined the facility failed to ensure the nursing services provided by the facility met professional standards of quality of care for three (3) of fourteen (14) active sampled residents, Resident number twenty-five (25), Resident number twenty-eight (28), and. Resident number thirty-three (33). This is evidenced by failure to follow physician's order for blood pressure medication for Resident number twenty-five (25); failure to follow physician’s order for hypnotic for Resident number twenty-eight (28), and failure to carry out physician's order for laboratory testing for Resident number thirty-three (33). Not following physician orders has the potential for ne gative resident outcomes. 26. . Areview of the medical record for Resident number twenty-five (25) revealed an admission date of July 12, 2007 from an acute care facility. The diagnoses included, but were not limited to, hypertension and osteoarthrosis of the shoulders. 27. The medication regimen included the following blood pressure medications: Norvasc 10 milligrams by mouth daily; Cozaar 50 milligrams by mouth twice a day; Lopressor 25 milligrams by mouth twice a day, and Diovan 169 milligrams by mouth daily. 28. The physician's discharge orders from the hospital and the facility's admitting orders specified the following parameters for each individual blood pressure medication: Hold for systolic blood pressure less than 120. 29. A review of the record failed to reveal evidence the blood pressure was monitored on July 14, 2007; July 15, 2007; July 16, 2007 and July 17, 2007 prior to administration of the medications. 30. On July 18, 2007 at 2:08 p.m. the Licensed Nurse documented this late entry for July 17, 2007, “Blood pressure 116/66. The Resident had refused Diovan initially when offered, but later in the day after discussing this with her, she did accept both Toprol and Diovan." There was no evidence in the record the nurse rechecked the blood pressure before administering the Toprol and Diovan. 31. During an interview with the nurse on July 18, 2007 at 2:20 p.m. she made the following statement: "I shouldn't have given it to her, but I did.” 32. During an interview with the Director of Nursing on July 18, 2007 at 2:30 p.m. she revealed that discharge orders from the hospital are verified with the physician prior to initiation of any medication or treatment. . 33. On July 19, 2007 at 9:25 a.m. the Director of Nursing revealed the nurse had been counseled and the physician had been notified of the medication error. She further stated the Pharmacy Consultant would review the medication regimen for the resident. 34. A review of the Pharmacy Consultant report dated July 19, 2007 revealed a recommendation to the physician to consider discontinuing Cozaar and increase Diovan as needed. - 35... On July 19, 2007 at 3:30 p.m. the Director of Nursing presented a verbal order from the physician dated July 19, 2007 which specified to discontinue Cozaar and add Diovan 80 milligrams at 9:00 p.m. . 36. Areview of the clinical record for Resident number twenty-eight (28) on July 18, 2007 at 3:00 p.m. revealed an admission date of June 23, 2004. The diagnoses included, but were not limited to, Diabetes Mellitus, Congestive Heart Failure, and Renal Failure. 37. The Medication Administration Record for July 2007 for Resident number twenty-eight (28) included the following routine medication, Ambien CR 6.25 1 tablet by mouth at bedtime with a start date of June 22, 2007. The Medication Administration Record also listed Ambien CR to be administered as necessary with a start date of June 1, 2007. A further review of the Medication Administration Record revealed the resident routinely received Ambien seventeen (17) times during July 2007. 38. | Acomplete review of the record revealed the following handwritten order dated May 31, 2007, Ambien CR 6.25 milligrams by mouth daily (as necessary). There was no evidence in the record the physician was notified and had approved the use of Ambien routinely for the resident. 39. An interview with the Licensed Nurse on July 18, 2007 at 3:30 p.m. revealed she must have had an order for the nightly Ambien. . 40. On July 19, 2007 at 1:40 p.m. the Licensed Nurse revealed she had not been able to locate any order dated June 22, 2007 authorizing the daily administration of Ambien. After surveyor's intervention, the nurse obtained the clarification from the physician. She presented a verbal order from the physician dated July 19, 2007 to discontinue the as needed use and continue the routine administration of Ambien CR 6.25 daily at bedtime. 41. A review of the clinical record for sample Resident number thirty-three (33) revealed a physician's order dated July 11, 2007 to obtain stool for occult blood, Hemoglobin, and Hematocrit and a urine analysis with culture if indicated. 42, A review of the nurse's notes dated July 12, 2007 revealed the resident "was noted to have a moderate amount of blood in stool... This was noted two days ago also, physician is aware...” There was no result available at the time of the review for the stool for occult blood or the urine analysis. The results were requested from the facility on uly 19, 2007 at 11:15am. At 11:30 a.m. on July 19, 2007 the Licensed Nurse stated the stool and urine specimens were never collected. 43. The nurse stated the order had been discontinued in the computer when the blood specimen was obtained. The nurse further stated, "I'm sorry, I missed it, I should have followed up on that." 44. On July 19, 2007 at 3:10 p.m., the Licensed Nurse stated she had contacted the physician. The nurse presented a renewed order from the physician to obtain the stool and urine specimens as previously ordered. 45. The Agency determined that this deficient practice will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. The Agency cited the Respondent for a Class III deficiency as set forth in Section 400.23(8)(c), Florida Statutes (2007). 46. . A Class Ill deficiency is subject to a civil penalty of $1,000 ‘for an isolated deficiency, $2,000 for a patterned deficiency, and $3,000 for a widespread deficiency. 47. Based upon the above findings, the Respondent’s actions, inactions or conduct constituted. an uncorrected Class III deficiency pursuant to Section 400.23(8)(c), Florida Statutes (2007). 48. The Agency provided Respondent with a mandatory correction date of August 19, 2007. WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND DOLLARS ($1,000.00) against Respondent, a skilled nursing facility in the State of Florida, pursuant to Sections 400.23(8)(c) and 400.102, Florida Statutes (2007). COUNTH.. : Assignment Of Conditional Licensure Status Pursuant To Section 400.23(7)(b), Florida Statutes (2007) 49. The Agency re-alleges and incorporates by reference the allegations in Count I. 50. The Agency is authorized to assign a conditional license status to skilled nursing facilities pursuant to Section 400.23(7), Florida Statutes (2007). 51. Due to the presence of one Class II deficiency that was not corrected within the time ’ established by the Agency, the Respondent was not in substantial compliance at the time of the survey with criteria established under Chapter 400, Part I, Florida Statutes (2007), and the rules adopted by the Agency. 52. The Agency assigned the Respondent conditional licensure status with an action effective date of July 19, 2007. The original certificate for the conditional license is attached as Exhibit A and is incorporated by reference. | 53. The Agency assigned the Respondent standard licensure status with an action effective date of August 23, 2007. The original certificate for the standard license is attached as Exhibit B and is incorporated by reference. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the Respondent conditional licensure status for the period between the assignment of the conditional license and the standard license pursuant to Section 400.23(7)(b), Florida Statutes (2007). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief against the Respondent as follows: 1. Make findings of fact and conclusions of law in favor of the Agency on Count I. 2. Impose an administrative fine against the Respondent in the amount of ONE. THOUSAND DOLLARS ($1,000.00). 3. Assign a conditional license to the Respondent for the period of July 19, 2007, to August 23, 2007. | 4. Assess costs related to the investigation and prosecution of this case. 5, Enter any other relief that this Court deems just and appropriate. Respectfully submitted this sf, day of October, 2007. tach aie Mobs, Senior Attorney Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (239) 338-3209 10 . NOTICE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TO RETAIN AND BE REPRESENTED BY AN ATTORNEY IN THIS — MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS. ALL REQUESTS FOR HEARING SHALL BE MADE AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE - ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 922-5873. THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No: 7006 2150 0004 5871 0804 on October sf _, 2007 to: Henry Bowen Gillespie, Administrator, Harbour Health Systems, LLC d/b/a Harbour Health Center, 23013 Westchester Boulevard, Port Charlotte, Florida 33980 and by U.S. Certified Mail, Return Receipt No: 7006 2150 0004 5871 0798 to C. T. Corporation, Registered Agent for Harbour Health Systems, LLC d/b/a Harbour Health Center, 1200 South Pine Island Road, Plantation, Florida 33324. vy) obs, Senior Attorney Florida Bar No. 0355712 Agency. for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (239) 338-3209 11 Copies furnished to: Henry Bowen Gillespie, Administrator Harbour Health Systems, LLC d/b/a Harbour Health Ceriter 23013 Westchester Boulevard Port Charlotte, Florida 33980 (U.S. Certified Mail) ~~ | C. T. Corporation, Registered Agent for Harbour Health Systems, LLC d/b/a Harbour Health Center 1200 South Pine Island Road Plantation, Florida 33324 (U.S. Certified Mail) _| Kriste J. Mennella Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (Interoffice Mail) Mary Daley Jacobs, Senior Attorney Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) ExhibitA Original Certificate of Conditional License For Harbour Health Systems, LLC d/b/a Harbour Health Center Certificate No. 14683 License No. SNF1504096 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST GOVERNOR September 20, 2007 HARBOUR HEALTH CENTER 23013 WESTCHESTER BLVD. PORT CHARLOTTE, FL 33980 Dear Administrator: ANDREW C. AGWUNOBI, M.D: SECRETARY The attached license with Certificate #14683 is being issued for the operation of your facility. Please review it thoroughly to ensure that all information is correct and consistent with your records. If errors or omissions are noted, please make corrections on a copy and mail to: Agency for Health Care Administration Long Term Care Section, Mail Stop #33 2727 Mahan Drive, Building 3 "Tallahassee, Florida 32308 Issued for a status change to Conditional. Sincerely Minn Agency for Health Care Administration Division of Health Quality Assurance Enclosure ce: AHCA Area Office 08 Long Term Care Section file Medicaid Contract Management Certificate of Need ; MEFLORIDA A COMPARE DARE Health Cara in the Sunshing " 2727 Mahan Drive, MS#33 - Tallahassee, Florida 32308 : _f wow FlordsComparecare.gov ea Visit AHCA online at hitp://ahca.myflorida.com Nour, ‘ aye ¥ AREY Hg en ote Pi th ie peas = ee ; Exhibit B Original Certificate of Standard License For Harbour Health Systems, LLC d/b/a Harbour Health Center Certificate No. 14684 | License No. SNF1504096 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST GOVERNOR September 20, 2007 HARBOUR HEALTH CENTER 23013 WESTCHESTER BLVD. PORT CHARLOTTE, FL 33980 Dear Administrator: ANDREW C. AGWUNOBI, M.D, SECRETARY Qs ey Bo 2 EF wen, O GS BA: . CEE oc Bae Bee F. QA ip CA “ The attached license with Certificate #14684 is being issued for the operation of your facility. Please review it thoroughly to ensure that all information is correct and consistent with your records, If errors or omissions are noted, please make corrections on a copy and mail to: Agency for Health Care Administration Long Term Care Section, Mail Stop #33 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308 Issued for a status change. Sincerely, Agency fot Health Care Administration Division of Health Quality Assurance Enclosure ce: AHCA Area Office 08 Long Term.Care.Section file Medicaid Contract Management Certificate of Need FLORIDA A COMPARE CARE Health Care In tha Sunshine 2727 Mahan Drive, MS#33 Tallahassee, Florida 32308 oe e dh ff mmiondacomparecare.sov Visit AHCA online at http://ahca.myflorida.com SENDER: COMPLETE THIS SECTION: COMPLETE.THIS SECTION ON DELIVERY = Complete items.4, 2, and 3. ‘Also complete, : itern 4 if Restricted Delivery Is desired, : ®@ Print your name and address on the | reverse j so that we can.retum the card to you... ooo @ Attach this card. to the back of: the ‘Malipiece,, * or on, the front If space permits. \ Se te) G. Data of Dallvery : l0fr4 D, [a delivery address different from item 1? Cl Yes IFYES, enter delivery address below: . C1 No B. Recelvad by (Printed Narn 1. Article Addressed tot 200700008 128 oe Henry B. Gillespis Adminis tea tor Hay bow Heath Center 23013 Westchester Bovlevard Port Char let Florida | 33980 2 arte Murti abo) 700 2280 ono4 5871 o8o4 1 (Transfer trom sevice (abe) 1 PS Form 3811; ; February 2004 Domestle Return Recelpt 402595-02-M-1540 .. Service Type ‘ Di certified Mal © Exprass Mal O Reg!stered 1 Return Receipt for Merchandise C1 insured Mall. 1 0,0,D. . Restricted Delivery? (Extra Fee) C Yes | } i } | { i | | i | ' Vn.

Docket for Case No: 07-005253