STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, ; vs, Case Nos. 2009014480 (Fines) 2009014481 (Cond.) GINGER DRIVE HEALTH CARE ASSOCIATES, LLC, d/b/a Heritage Health Care 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 GINGER DRIVE HEALTH CARE ASSOCIATES, LLC, d/b/a Heritage Health Care Center, (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2009), and alleges: NATURE OF THE ACTION This is an action to change Respondent’s licensure status from Standard to Conditional commencing December 22, 2009 and ending January 21, 2010. This is also an action to impose an administrative fine in the amount of $1,000.00, based upon Respondent being cited for one uncorrected State Class IIT deficiency. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2009). 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of nursing homes and Filed April 7, 2010 12:35 PM Division of Administrative Hearings. enforcement of applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4, Respondent operates a 180-bed nursing home, located at 3101 Ginger Drive, Tallahassee, Florida 32308, and is licensed as a skilled nursing facility license number 12210961. 5. Respondent was at all times material hereto, a licensed nursing facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes. COUNT I RESPONDENT’S FACILITY FAILED TO PREPARE MEDICATIONS FOR ADMINISTRATION IN ACCORDANCE WITH PHYSICIAN’S ORDERS AND FACILITY POLICIES AND PROCEDURES Fla. Admin, Code R. 59A-4,107(5) ISOLATED UNCORRECTED CLASS II DEFICIENCY 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. Florida law provides the following: Rule 59A-4.107(5), F.A.W, 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. 8. That from November 2, 2009 through November 6, 2009 the Agency conducted an annual licensure survey and complaint investigation (CCR 2009011662) at Respondent’s facility. 9. Based on observation, interview and record review, the facility failed to follow physician orders in the preparation and administration of medications for 2 of 10 sampled residents, #13 and #112. The findings were: 10. A medication pass observation was conducted on November 4, 2009 with Nurse #1 beginning at approximately 8:27a.m. LL. The nurse was preparing medications for administration to Resident #13. 12. According to physician orders, Resident #13 was scheduled to receive: Cytra-2 Oral Solution, 30m (milliliters) Sodium Polystyrene Sulfonate (SPS), 60ml Ferrous Sulfate 325mg, 1 tablet Alphagan P 0.15% 1 eye drop each eye Xalatan 0.005% 1 eye drop each eye Cosopt eye drops, 1 drop each eye 13. Nurse #1 failed to prepare the Cytra-s Oral Solution and offer the medication to Resident #13. 14. For the SPS, the nurse only poured 30cc of the medication and offered this to the resident. The nurse failed to prepare the entire ordered dose of 60ce. 15. The nurse obtained a stock box of Ferrous Sulfate and poured 1 tablet into a medicine cup for administration. The milligrams of medication were not indicated on the front of the stock box. An interview was conducted with the nurse at this time. 16. The nurse was asked how many milligrams of ferrous sulfate the tablet contained. The nurse looked on the back of the box and stated that each tablet was 160mg. 17. The nurse stated that the 160mg tablet in the cup was the correct dose because the order stated to give 1 tablet. 18. The nurse was observed to hand Resident #13 the three bottles of Glaucoma eye drops one at a time. 19. The nurse watched while Resident #13 administered the three medications back to back without waiting in between. | 20.. Facility policy and medication reference manuals stated that the eye drops should have been administered 5-10 minutes apart. While the resident was administering the third different eye drop, the nurse stated, "I know that you are supposed to wait awhile between eye drops, but (the resident) won't wait. " 21, Nurse #7 was observed administering medications to Resident #112 beginning at 8:15a.m. on 11/5/09. 22, The nurse was observed administering 15 different medications to the resident. 23. Resident #112 was scheduled to receive Dialysis the morning of 11/5/09, The resident left for the dialysis appointment about an hour after receiving the 15 medications. 24, A record review was conducted for Resident #112. 25. There was a current physician order to give all morning medications after dialysis. This order had been transcribed onto the Nurse's Medication Administration Record. 26, On November 5, 2009 at approximately 9:15a.m., an interview was conducted with Nurse #7, 27. The nurse stated that she had held all of the resident ' s blood pressure medications due to upcoming dialysis. The nurse was unaware of the order to hold all medications. 28. On November 5, 2009 at approximately 9:20a.m., an interview was conducted with the acting Director of Nursing and the Unit 3 Manager. 29, They confirmed that the physician order to give all morning medications was current. 30, The Agency provided Respondent with the mandatory correction date for this deficient practice of December 6, 2009. 31. That from December 21, 2009 through December 22, 2009 the Agency conducted a follow-up survey to the annual licensure survey and complaint investigation (CCR 2009011662) at Respondent’s facility. 32. Based on observation, interview, and record review, the facility failed to prepare medications for administration in accordance with physician's orders and facility policies and procedures for 1 of 10 sampled residents, resident #147. The findings were: 33, Medication pass observation was conducted on December 21, 2009 at approximately 10:30 a.m. 34. A licensed nurse observed preparing Advair Metered Dose Inhalant (MDI) for resident #147. The licensed nurse handed MDI to resident and resident inhaled per nurse's verbal - instructions, 35. The licensed nurse did not evaluate breath sounds, cough effort and sputum production, heart rate or respiratory rate in accordance with facility policy and procedure. 36, The licensed nurse failed to instruct and/or assist resident to rinse mouth following the administration of the medication as per manufacturer's instructions and facility policy and procedure. 37. An interview on December 21, 2009 at approximately 10:40 a.m. with licensed nurse revealed licensed nurse stated the resident sometimes drinks after medications are administered. 38. Physician order dated December 1, 2009 for Advair 250/50 Deskus. Inhale 2 puffs into lungs twice a day for asthma. Rinse mouth. Do not shake. Hold horizontally. — 39. A review of facility policy and procedure for Medication Administration-Metered Dose Inhaler (MDI) stated in procedure to evaluate respiratory status to include, but not be limited to breath sounds, cough effort and sputum production, heart rate and respiratory rate. 40. The procedure further stated to instruct resident to rinse mouth, especially if a steroid was administered. Advair is a corticosteroid inhalant. 41, The Agency provided Respondent with the mandatory correction date for this deficient practice of January 22, 2010. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, a skilled nursin g facility in the State of Florida, pursuant to §§ 400.23(8)(c) and 400.102, Florida Statutes (2009). COUNT I 42. The Agency re-alleges and incorporates Counts I of this Complaint as if fully set forth herein. | 43. Based upon Respondent’s uncorrected State Class III deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part II of Florida Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Florida Statutes (2009). WHEREFORE, the Agency intends to assign a conditional licensure status to Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(7), Florida Statutes (2009) commencing December 22, 2009 and ending January 21, 2010.. CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court: (A) Make factual and legal findings in favor of the Agency on Count I and II; (B) Recommend an administrative fine against Respondent in the amount of $1,000 for Count I; (C) Assign a conditional licensure status commencing December 22, 2009 and ending January 21, 2010; (D) Assess attorney’s fees and costs; and - (BE) Grant all other general and equitable relief allowed by law. 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 form. All requests for hearing shall be made to the attention of Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS - #3, Tallahassee, Florida 32308, (850) 922-5873. 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. Respectfully submitted this lod day of March, 2010. Carlton Enfinger Fla. Bar.0793450 Agency for Health Care Admin. 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 °850.412.36300 (office) 850.921.0158 (fax) 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. 7004 2890 0000 5526 4918 to Facility Administrator Anthony J. Pileggi, Heritage Health Care Center, 3101 Ginger Drive, Tallahassee, Florida 32308, by U.S. Certified Mail, Return Receipt No. 7004 2890 0000 5526 4925 to Registered Agent Corporation Service Company, 1201 Hays Street, Tallahassee, Florida 32301, and via email to Anna Gay Small, Esq., Broad and Cassel, 215 S. Monroe Street, Suite 400, Tallahassee, Florida 32301 on March £2, 2010: i Carlton Enfinger Copy furnished to: Barbara Alford, FOM

Docket for Case No: 10-001841