Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: ARC VILLAGES IL, LLC, D/B/A FREEDOM POINTE AT THE VILLAGES REHABILITATION AND HEALTHCARE
Judges: LISA SHEARER NELSON
Agency: Agency for Health Care Administration
Locations: Tallahassee, Florida
Filed: Oct. 22, 2010
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, November 3, 2010.
Latest Update: Dec. 25, 2024
STATE OF FLORIDA
ARE ADMINISTRATION
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION,
Petitioner,
vs. Case Nos. 2010008287
2010008288
ARC VILLAGES IL, LLC d/b/a FREEDOM
POINTE AT THE VILLAGES REHABILITATION
AND HEALTHCARE,
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 ARC
Villages IL, LLC d/b/a Freedom Pointe at the Villages Rehabilitation and Healthcare,
(hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2010), and
alleges:
NATURE OF THE ACTION
This is an action to change Respondent’s licensure status from Standard to Conditional
commencing July 8, 2010 and ending August 16, 2009, and impose an administrative fine in the
amount of one thousand dollars ($1,000.00), based upon Respondent being cited for one
uncorrected isolated State Class HI deficiency.
JURISDICTION AND VENUE
1, The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2010).
Filed October 22, 2010 3:54 PM Division of Administrative Hearings.
oT
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
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),
Chapters 400, Part I, and 408, Part II, Florida Statutes, and Chapter 59A-4, Florida
Administrative Code.
4. Respondent operates a 72-bed nursing home, located at 1460 Ef Camino Real, The
Villages, Florida 32159, and is licensed as a skilled nursing facility license number 130471043.
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
6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set
forth herein.
7. That 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,
8. That pursuant to Florida faw, each facility shall adopt procedures that assure the accurate
acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the
needs of each resident. Rule 59A-4.112(1), Florida Administrative Code.
9. That on or about May 28, 2010, the Agency conducted a compliance complaint
investigation of Respondent’s facility.
10. That based on observation, the review of records, and interview, Respondent failed to
follow physician's orders for acquiring and administering medications for two (2) of four (4)
sampled residents, the same being contrary to the minimum requirements of law.
11. That Petitioner’s representative reviewed Respondent’s records related to resident
number one (1) and noted as follows:
a,
The resident was admitted from the hospital to Respondent facility on May 5,
2010 for rehabilitation and intravenous (IV) therapy;
The resident had a history of urinary tract infection, and E Coli Septicemia for
which the resident was ordered intravenous (IV) antibiotics;
Discharge physician’s orders from the resident's hospitalization dated May 3,
2010 provided;
i. "1 gram (GM) of Vancomycin intravenous (IV) every !2 hours for 2
weeks,"
ii. "2 gram (GM) of Ceftazidime (Fortaz) IV every 12 hours for 2 weeks."
The resident's facility physician had ordered and written on May 5, 2010 to
start Vancomycin 1 gram in Dextrose 5% 250 milliliter (ml) via IV every 12
hours at 6:00 AM and 6:00 PM and infused over two hours.
Also ordered was Ceftazidime (Fortaz) 2 gram in normal saline (ns) 0.9% 100
ml via IV every 12 hours at 9:00 AM and 9:00 PM.
These medications were medically necessary for treatment of the resident’s
septicemia;
The resident’s Medication Administration Record (MAR) reflected as follows:
i. The resident arrived at this facility on May 5, 2010 at 2:20 PM
ii, Respondent failed to administer the resident’s prescribed IV antibiotic of
Vancomycin at 6:00 PM
iii. Respondent failed to administer the resident’s prescribed IV antibiotic of
Ceftazidime (Fortaz) at 9:00 PM
iv. Respondent failed to administer on Masy 6, 2010 the resident’s prescribed
TV antibiotic of Vancomycin at 6:00 AM and the resident’s prescribed IV
antibiotic of Ceftazidime (Fortaz) at 9:00 AM.
Nursing notes did not reflect that the resident’s physician had been notified on
May 5 or 6, 2010 of Respondent’s failure to administer the prescribed doses of
IV antibiotics as above referenced;
The medication administration record for the resident had circles for the dates
and times of administration for the missed dosages referenced above which
reflected that the antibiotics were not administered;
Noted on the back of the medication administration record was that the
antibiotics Vancomycin and Ceftazidime (Fortaz) were not given and
unavailable from the pharmacy;
The resident’s medication administration record (MAR) also reflects that the
resident was scheduled to receive additional physician ordered medications
starting on May 5, 2010 and the following additional medications were not
administered on the following dates:
i, Sinemet 25-100 mg ordered one tablet to be administered every 8 hours,
not administered on May 5, 2010 at 10:00 PM and noted unavailable from
the pharmacy;
pan
iti.
vi.
vii.
viii.
. Colace100 mg ordered one tablet to be administered once a day, not
administered on May 5, 2010 at 5:00 PM and noted unavailable from the
pharmacy;
Lopid 600 mg ordered one tablet to be administered twice a day, not
administered on May 5, 2010 at 9:00 AM and 9:00 PM, or May 26, 2010
at 9:00 AM and noted unavailable from the pharmacy;
Lactinex one chewable tablet ordered to be administered once a day, not
administered on May 5, 2010 at 5:00 PM and noted unavailable from the
pharmacy;
Megace oral suspension 400 ml /4 ml ordered to be administered once a
day, not administered on May 5, 2010 at 9:00 AM and noted unavailable
from the pharmacy;
Protonix 40 mg ordered to be administered once a day, not administered
on May 5, 2010 at 9:00 PM and noted unavailable from the pharmacy;
Mirapex 0.125 mg ordered one tablet to be administered once a day, not
administered on May 5, 2010 at 9:00PM or May 6, 2010 at 9:60 PM and
noted unavailable from the pharmacy;
Flomax 0.4 mg ordered one tablet to be administered once a day, not
administered on May 5, 2010 at 9:00 PM and noted unavailable from the
pharmacy;
Hytrin 5 mg ordered one tablet to be administered once a day, not
administered on May 5, 2010 at 9:00 PM and noted unavailable from the
pharmacy;
x. Detrol LA 4 mg ordered one tablet to be administered once a day, not
administered on May 5, 2010 at 9:00 AM and noted unavailable from the
pharmacy;
xi. Effexor XR 37.5 mg ordered one tablet to be administered once a day, not
administered on May 5, 2010 at 9:00 AM and noted unavailable from the
pharmacy;
Commencing May 20, 2010, a physician order required the administration of
Hytrin 6 mg one tablet to be administered once a day;
The resident’s medication administration record (MAR). reflects that the
Hytrin 6 mg was not administered as ordered on May 20, or 21, 2010 at 9:00
PM and noted unavailable from the pharmacy.
12. That Petitioner’s representative interviewed Respondent’s risk manager during the survey
regarding the failure to administer prescribed medications as ordered for resident number one (1)
and the risk manger indicated as follows:
a.
The resident’s prescribed medications were delivered from pharmacy the
same day that the resident was admitted;
Respondent had an agency nurse that sent the medications back to the
pharmacy and did not administer the medications;
On May 13, 2010Respondent conducted an in-service for nursing staff
regarding new admissions of residents as well as all residents receiving their
medications in a timely manner as ordered by the physician.
13. - That Petitioner’s representative reviewed the in-service roster of nurses attending the
training program and noted as follows:
14.
a. Only eight (8) of Respondent’s twenty (20) nursing staff members had
attended the in-service program;
b. ‘One of the nursing staff members who had failed to administer prescribed
medications to resident number one (1) on May 5 and 6, 2010, as above
described, and failed to administer prescribed Hytrin 6 mg on May 20 and 21,
2010, was not documented as having attended the medication in-service
presentation.
That Petitioner’s representative reviewed Respondent’s records related to resident
number three (3) and noted as follows:
15.
a. The resident’s medication administration record (MAR) indicates the resident
is scheduled to receive physician ordered medications starting on February 11,
2010;
b. The following prescribed medications were not documented as administered
on the following dates:
i. Glumetza-I ordered to be administered 1 dose once a day, not
administered on February 11, 12, 13, 14, 15, and 16, 2010 at 9:00 AM and
noted unavailable from the pharmacy;
ii, Lasix 40 mg ordered one tablet to be administered twice a day, not
administered on March 2, 2010 at 5:00 PM and noted unavailable from the
pharmacy;
iii. Megace 10 ml ordered to be administered twice a day, not administered on
March 6, 7, and 8, 2010 at 4:30 PM and noted unavailable from the
pharmacy.
That the above reflects Respondent's failure to ensure that all physicians’ orders are
followed as the same relate to the timely acquiring and administering of medications includin;
but not limited to where the medications were timely delivered and not provided as prescribed.
16. That said failure is contrary to the requirements of law.
17. That the Agency determined that these failures relate to the operation and maintenance of
a facility or to the personal care of residents that indirectly or potentially threaten the physical or
emotional health, safety, or security of facility residents cited this deficient practice as an
Isolated State Class III deficiency.
18. That Respondent was given a correction date of July 28, 2010.
19. That on or about July 8, 2010, the Agency conducted a revisit to this complaint
investigation of Respondent’s facility.
20. That based on observation, the review of records, and interview, Respondent failed to
follow physician's orders for acquiring and administering medications for one (1) of six (6)
sampled residents, the same being contrary to the minimum requirements of law.
21, That Petitioner’s Representative reviewed Respondent’s records related to resident
number one 91) during the survey and noted as follows;
a. The resident was admitted to the facility on July 7, 2010 at 1:30PM with a
primary diagnosis of gastroenteritis;
b. The resident’s medication administration record (MAR) documented that on
July 7, 2010 the following medications were ordered: Synthroid 150 mcg |
tab daily AC breakfast; Remeron 15 mg 1 tab daily at bedtime (9:00 PM);
Duoneb 0.5-2.5 mg/3ml every 6 hours via nebulizer; Effexor XR 150 mg 1 tab
daily (9:00 AM); Protonix 40 mg once daily (6:00 AM); Femara 25 mg 1 tab
daily (9:00 AM); Toprol XL 100 mg 1 tab daily (9:00 AM); Zocor 40 mg t
tab daily (9:00 AM); Agrylin 0.5 mg 1 twice daily (9:00 AM and 9:00 PM);
¢. That none of these medications had not been received or administered to the
resident for any prescribed dosage or time by !1:50 PM on July 8, 2010.
22. That Petitioner’s representative interviewed Respondent’s day nurse assigned to resident
number one (1) on July 8, 2010 at 10:15 AM who indicated as follows:
a. The night nurse had told the her that the medications for the resident had not
been delivered to the facility;
b. She had called the pharmacy after being informed that the medications were
not delivered;
c. She was told by the pharmacy that the they had never received the faxed
orders from the facility and that she needed to re-fax the orders;
d. The fax conformation report dated July 8, 2010 at 7:38 AM revealed that the
medication orders for the resident were re-faxed to the pharmacy;
e, She stated that the pharmacy stated that the medications would be sent to the
facility STAT;
f A STAT order is to be delivered within three (3) hours, however the
medication stift had not arrived at the time of the interview.
23. That Petitioner’s representative interviewed Respondent’s unit manager regarding
resident number one (1) on July 8, 2010 at 10:30 AM who indicated that she had admitted the
resident the day before and had faxed the medication orders to the pharmacy, but the was unable
to find the fax conformation for the orders.
24. That Petitioner’s representative reviewed of the medical record of resident number one
(1) and noted a nursing note dated July 7, 2010 at 1:30 PM that stated "Meds varied and faxed to
pharmacy".
25. That Petitioner’s representative interviewed Respondent’s risk manager regarding
resident number one (1) on July 8, 2010 at 10:32 AM who indicated as follows:
a, The pharmacy makes two daily deliveries, one at 6:00 AM and again at 9:00
PM;
b. If medications are not delivered, the nurse on duty is to call the pharmacy and
report to them that they did not get all the medications ordered.
26. That Petitioner’s representative reviewed of the medical record of resident number one
(1) and could locate no indication that either Respondent’s evening nurse on July 7, 2010 or the
night nurse on July 7 -- 8, 2010 had called the pharmacy when the medications did not arrive on
the 9:00 PM or 6:00AM deliveries.
27. That Respondent’s unit manager could not produce any communication records of either
of the two nurses referenced above calling the pharmacy.
28. That Petitioner’s representative continued to interview Respondent’s day nurse on July 8,
2010 at 11:15 AM who indicated that she did not get any of the medications from the automated
medication dispensing unit, or Pyxis, because the mediations for the resident were either not in
the Pyxis machine or were not the same dose as the medications in the Pyxis.
29, That Petitioner’s representative reviewed the list of medications contained in the Pyxis
and noted that the prescribed medications for resident number one (1), Toprol XL 100 mg 1 tab,
Zocor 40 mg 1 tab, and Remeron 15 mg | tab, were listed as being available to be dispensed.
30. That Petitioner’s representative noted that no indication on the medication administration
record of resident number one (1) indicated that the above referenced medications were removed
from the Pyxis and administered to the resident.
31. That Petitioner’s representative reviewed the Agenda for the Nursing Meeting of June 10,
2010 which reflected as follows: “Nurses re-inserviced on medication delivery/administration in
a timely manner. If med ordered not delivered before next scheduled administration time nurses
10
are to a) check pyxis inventory list, located behind the med room doors, to see if medications is
usually kept in the pyxis; b) if medication is not available through pyxis, place call to pharmacy
in
the nurse must then notify the physician that we are unable to obtain this medication and will
need a sub (substitute) or an order to hold this medication until available from the pharmacy; d)
unit managers/supervisors will routinely review the mar/tar ensure completion".
32. That Petitioner’s representative noted that no indication on the medical record of resident
number one (1) reflected that the evening or night nurse had checked the Pyxis, had called the
pharmacy to arrange delivery through a local vendor, or had called the physician to obtain
direction about the medication until the medication was available from the pharmacy.
33. That Petitioner’s representative interviewed Respondent’s day nurse on July 8, 2010 at
10:15 AM who confirmed that the physician had not been notified that the medications were not
available.
34. | That the above reflects Respondent’s failure to ensure that all physician’s orders are
followed as the same relate to the timely acquiring and administering of medications including
but not limited to where the medications were maintained by the facility and not provided as
prescribed,
35, That Respondent had a duty to follow all physician orders as prescribed, and if not
followed, to record the reason on the resident’s medical record during that shift.
36. | That Respondent has failed to fulfill this responsibility.
37. That these failures, collectively and individually, constitute intentional or negligent acts
that materially affected the health or well being of the resident.
38. That the Agency determined that these failures relate to the operation and maintenance of
a facility or to the personal care of residents that indirectly or potentially threaten the physical or
emotional health, safety, or security of facility residents cited this deficient practice as an
Uncorrected Isolated State Class ITI deficiency.
WHEREFORE, the Agency seeks to impose an administrative fine in the amount t of
$1,000.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §
400.23(8)(c), Florida Statutes (2010).
COUNT H
39. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Count I
of this Complaint as if fully set forth herein.
40. 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)(a), Florida Statutes (2010).
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 (2010) commencing July 8, 2010 and ending August 16, 2010.
Respectfully submitted this 1 day of October, 2010.
Thérhds J. Walsh Il, Esquire
Bar. No. 566365
gency for Health Care Admin.
525 Mirror Lake Drive, 330G
St. Petersburg, FL 33701
727.552.1525 (office)
DISPLAY OF LICENSE
Pursuant to § 400.23(7)(e), Fla. Stat. (2009), Respondent shall post the most.current license ina.
prominent place that is in clear and unobstructed public view, at or near, the place where
residents are being admitted to the facility.
Respondent is notified that it has a right to request an administrative hearing pursuant to Section
120.569, Florida Statutes. Respondent 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 to the attention of: The Agency Clerk, Agency for Health
Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850)
922-5873.
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.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has beeryserved by
US. Certified Mail, Return Receipt No: 7004 2890 0000 526 7087 on October D , 2010 to
Russell Ward, Administrator, ARC Villages IL, LLC d/b/a Freedom Pointe at the Villages
Rehabilitation and Healthcare, 1460 El Camino Real, The Villages, Florida 32159, and by U.S.
Mail to C T Corporation System, Registered Agent, ARC Villages IL, LLC d/b/a Freedom
Pointe at the Villages Rehabilitation and Healthcare, 1200 South Pine Island Road, Plantation,
FL 33324,
J. Walsh H, Esquire
Russell Ward, Administrator
Vi C d/b/a Freedom _____|
Pointe at the Villages Rehabilitation and
Healthcare
1460 El Camino Real
The Villages, Florida 32159
(U.S. Certified Mail)
Kris Mennella,
Field Office Manager
14101 NW Hwy., 441
Suite 800
Alachua, Florida 332615
(U.S. Mail)
C T Corporation System
istered Agent, 00
ARC Villages IL, LLC d/b/a
Freedom Pointe at the Villages
Rehabilitation and Healthcare
1200 South Pine Island Road,
Plantation, FL 33324
.S. Mail
Thomas J. Walsh II, Esquire
Senior Attorney
Agency for Health Care Admin.
525 Mirror Lake Dr., N., #330G
St. Petersburg, Florida 33701
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