STATE OF FLORIDA , AGENCY FOR HEALTH CARE ADMINISTRATION | STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, | ¥8, Case No. 2010011020 CATALINA GARDENS HEALTH CARE ASSOCIATES, LLC, do/a Respondent. MINISTRATIVE COMP. COMES Now the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “Petitioner” or “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against CATALINA GARDENS HEALTH CARE ASSOCIATES, LLC, d/b/a BROOKSHIRE (THE) (hereinafter “Respondent”), pursuant to § 120.569 and § 120.57, Fla, Stat, (2010), and alleges: NATURE OF THE ACTION . This is an action to impose an administrative fine in the amount of five hundred dollars ($500.00) and a survey fee in the amount of five hundred dollars ($500.00) based upon one (1) uncorrected cited State Class III deficiency pursuant to § 429.19(2)(C) and § 429.19(7), Fla. Stat. (2010) for a total assessment of one thousand dollars ($1,000.00). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to § 20.42, § 120.60 and Chapters 408, Part II, and 429, Part I, Fla, Stat. (2010). Filed February 3, 2011 10:53 AM Division of Administrative Hearings Bob, 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. | PARTIES 3, ° The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable regulations, state statutes and rules governing assisted | , living facilities pursuant to the Chapters 408, Part II, and 429, Part I, Florida Statutes, and | Chapter 58A--5, Florida Administrative Code. . 4, Respondent operates an 125-bed assisted living facility (hereafter “ALF”) located at 85 | | , ' 5. Respondent 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 one (1) through five (5) as if fully set forth herein. | . 7, That pursuant to Florida law, “[t]he facility ‘shall make every reasonable effort to ensure , that prescriptions for residents who receive assistance with self-administration of medication or ___ tedication administration are filled or refilled in a timely manner.” Fla, Admin, Code R. S8A- 5.0185(7)(f). : 8. . That on 07/14/10, the Agency conducted a Complaint Investigation Survey (CCR No. 2010005790) of the Respondent's facility. 9. That based on record review and interview, Respondent failed or refused to make every reasonable effort to ensure that prescription were filled or refilled in a timely manner for five (5) of seven (7) sampled residents who received assistance with self-administration of medications, specifically Resident No. 1, Resident No. 2, Resident No. 3, Resident No. 4 and Resident No. 6, hereafter “RI”, “RO”, “R3”, “R4”, and “R6”, el ee Page 2 of 13 we Me 10. That it is the Respondent faoility’s responsibility to assess the resident’s medication supply if the medications are not kept by the resident. 11, That with respect to R1: a, Resident record review on 07/14/10 at approximnately 11:00 AM for Ri revealed a Health Assessment Report Form 1823 (hereafter “1823”) dated 06/21/10 that indicated diagnoses of COPD, bronchitis, ESRD, CHF, BPH, PAD and history of , prostate cancer. Per assessment, R1 needed assistance with medications. b,_The_May—2010_Medication—Observation. Record (hereafter “MOR”)—listed- Glipizide 5 mg, Metoprolol (Loptessot’) 25 mg daily except on dialysis days ( T. Th and Sat) had staff initials circled from 6/1 to 6/24; Metoprolol 25 mg half tablet every evening had staff initials circled from 6/1 to 6/17 when it was put on : hold. Entries on the back of the MOR indicated the.Metoprolol was not given, “awaiting arrival” from 5/1 to 05/21/10; Glipizide was not given, “awaiting ) atti from 5/3 to 05/27/10, Lipitor 10 mg and Singulair 10 mg had staff initials circled from 5/1 to 05/17/10. Entries on the back of the MOR indicated thot the Lipitor and Singulair were not given “unavailable”, . c. The June 2010 MOR listed Lipitor 10 mg at bedtime. The MOR had staff initials circled on 6/1 through 6/4 and 6/22 through 06/30/10, Entries on the back of the MOR indicated that the Lipitor 10 mg at bedtime was not given on the dates mentioned above because it was not available, unavailable. On 6/3 and 6/4 the MOR documented that the nurse, Staff No. 1, was aware the Lipitor was not available on said dates. d, The July 2010 MOR listed Crestor 5 mg once daily and Nephro-vite tablets one tablet daily. The MOR had staff initials circled from 7/1 to 07/14/10. Entries on ° Page 3 of 13 A? aed the back of the MOR indicated that the Crestor and Nephro-vite were not given on the dates mentioned above because it was “not available, unavailable”. e. Continued review revealed no notations that indicated what efforts Respondent’s - facility took to ensure that the resident medications were available at all times, . 12, That with respect to R2: ; . | a, R2 had an 1823 dated 06/29/09 that indicated diagnoses of DM, MS, dementia, HIN and osteoporosis; assistance was needed with medications. examined the resident on 06/26/10 and indicated “Bxtra_ eval per staff pt’s pharmacy account is frozen and can’t get meds-asked to eval med regime to see if atry meds can be reduced or d/c. Pt? POA bave been contacted and s/he refuses to __ pay for meds”. “Patient is terminal and hospice -d/c meds not necessary for care and comfort, COPD-on oxygen, Advair and theophylline these are most likely needed,” o. ‘The June 2010 MOR listed Calcium 600 plus D , omeprazole 20, ferrous sulfate 324 mg and vitamin C 500 mg and were d/c 06/29/10. The MOR also listed Lexapro 10 mg, Metformin HCL 500 mg, Diltiazem ER 90mg. The MOR had staff initials circled for the calcium 600 plus D, omeprazole 20, ferrous sulfate 324 mg and vitamin C 500 from 6/13 to 06/29/10 when they wete discontinued. The Lexapro 10 mg, Metformin HCL 500 mg, Diltiazem BR 90 mg, also had staff initials circled from 6/13 to 06/29/10. The back page of the MOR indicated that from 6/13 at 9:00 AM to 06/29/10 at 6:00 AM the above listed medications were not given because they were “not available, account frozen, unavailable”, An entry dated 06/27/10 (time not indicated) documented that “medication circled not Page 4 of 13 : given (POA) notified”. Another June 2010 MOR listed acetaminophen 325 mg and had staff initials, circled from 6/9 to 6/21 and 06/27/10; docusate sodium. 100 mg had staff initials from 6/4 to 06/21/10 and Advair discus 25/50 had staff initials circled from 6/18 to 06/21/10. Skin prep to both heels was indicated, on the back page of the MOR as “not available” from 6/1 to 06/30/10. Simvastatin 40 © mg had staff initials circled from 6/17 to 06/29/10 when it was discontinued. On 6/17 it was indicated that “pharmacy informed”. The back page of the MOR indicated that the-above listed medications-were-not-given-beoanse-they-werenot- available, account frozen, unavailable”, . ) d. The July 2010 MOR listed Lexapro 10 mg and Diltiazem ER 90 mg and had staff initials circled from 7/1 to 7/6 then was d/c,- Acetaminophen 325 mg had staff initials circled from 7/7 to 7/14 (survey date), skin prep to heels, had staff initials circled from 7/1 to 07/14/10. The back page of the MOR indicated that the above listed medications were not given because they were “not available, account frozen, unavailable”, e, Continued teview revealed no notations that indicated what reasonable efforts the facility took besides calling the POA a few times, to ensure that the -resident’s medications were available at all times. 13, That with respect to R3: | a, R3 had an 1823 undated dated 06/29/09 that indicated A- fibs, right breast cancer and history of pancreatitis, The assessment did not address the resident's needs regarding medications. The resident’s family member was the Power of Attorney. b. The June 2010 MOR listed Levothyroxine 137 meg one daily, the MOR had staff initials circled from 6/16 to 06/30/10. Lasix 20 mg one (1) daily had staff initials Page 5 of 13 circled from 6/27 to 06/30/10, The back page of the MOR indicated that on 6/15 “no meds given -account frozen, (POA) notified”. Syntheoid - was documented not given frémn 6/17 to 06/29. The back page entry indicated “account frozen, unavailable, and not available”, On, 6/24 it was documented that two (2) nurses were made aware, The MOR also listed Protonix 40 mg once daily, Lexapro 10 mg daily, and Carvedilol 6.25 mg one (1) twice daily, Oyster Shell calcium 500 mg one (1) tablet twice daily. The back page of the MOR indicated that on 6/14 at 9:00_AM_Coreg—was—‘not_given,unavailable”,64.4 @-5:00-PM_Coreg—and Calcium “unavailable-account frozen”, Continued entries from 6/16 to 6/29 indicated that medications were “unavailable-account frozen” for Protonix 40 mg once daily, Lexapro 10 mg daily, Carvedilol (Coreg) 6.25 mg one (1) twice daily and Oyster Shell calcium 500 mg. . Facility note datéd 06/14/10 indicated “Resident-has no meds. Called pharmacy, informed that resident’s account is frozen due to nonpayment. (POA) was called”, . Facility note dated 07/6/10 indicated that son was spoken io regarding frozen account. The POA indicated that s/he would call the pharmacy. Facility note dated 07/07/10 indicated that staff spoke with resident's family regarding the account being frozen, Family stated that s/he was unable to pay and would call family who was POA, On 7/8 the note indicated that medications were discussed with POA and payment to pharmacy. . Continued review revealed no notations that confirmed what measures _ Respondent's facility took to ensure that the resident's medications were available at all times. Page 6 of 13 -) ne 14. That with respect to R4: a. R4 had an 1823 dated 08/27/09 that indicated diagnoses of DM, HTN, memory ae oon loss and prolapsed bladder. Per assessment the resident needed assistance with medications. Facility notes dated 02/09/10 through 06/25/10 indicated that the R4's son was called on 2/19, 2/22, 3/15, 3/15, 4/7, 4/11, 5/26, 6/25 to inform son that R4 was out of medications, Namenda and Quinapril most often. . The June 2010 MOR indicated that Aricept was unavailable from 6/1 to 06/07/10. 15. R4’s account was frozen until payment was made. The back page of the MOR documented that on 6/4 “waiting on son to deliver”; 6/6 and 6/7 “waiting on (family)”, On 6/8 the entry documented that the pharmacy was contacted and the account was frozen until payment was made. . The July 2010 MOR indicated that.Carbidopa (Simenet) was not available from _ 115 to 7/10, On 7/5, 7/7 it was documented that family was called, : Continued review revealed no notations that confirmed what measures Respondent’s facility took to ensure that the resident's medications were available at all times, besides calling the family. That with respect to R6: a, R6 had an 1823 dated 03/23/10 that indicated diagnoses of COPD, iron deficiency, pericardial infraction and thrombocytosis. Per assessment the resident ’ needed assistance with medications. The resident had a designated Power of Attomey. . The June MOR indicated that-on 6/13 Proscar 5 mg, Folic Acid, Prilosec 20 mg, Verelan 240 mg Mag SR 64 mg were not given because “waiting on delivery”. Page 7 of 13 On 6/14, 6/15, Folic Acid, Prilosec 20 mg, Ferrous sulfate were “unavailable”, The pharmacy was notified on 06/15/10. On 6/17 Ferrous sulfate “unavailable, pharmacy already notified”. | On. 06/27/10 Verelan, Ferrous Sulfate, and Finasteride “were not given ~ not available - ordered 6/27". c. The July 2010 MOR indicated that Ambien 5 mg one (1) or two (2) at bedtime as needed for insomnia was not available 7/6 and 7/8. Simvastatin 20 mg at bedtime was “not available - ordered 710”. On 7/12 Simvastatin was indicated as ved. -16, That continued review revealed no notations that confirmed what measures Respondent’s facility.took to ensure that the pattern of unavailable medications was resolved. Respondent's facility had no evidence to confirm that all reasonable. efforts were made to ensure that that medications were filled or refilled in timely manner at all times such as request professional _ samples from healthcare provider or contact locel social services agencies for additional medication coverage. 17. That Respondent’s nursing supervisor stated on said date and time that not all POAs were responsible for finances of the resident, She stated that it was unfair to be cited when they had ~ done all they could. 18. That Respondent’s Administrator stated Respondent’s facility did not have a written policy xegarding ordering and re-ordering of medications, The staff was instructed to document for three (3) days they do something - call family. She added ‘that the facility bought medications " for some residents in the past and she did not know what else do to if families did not bring in the medications because they could not afford them or simply tefuged. Other resident ordered their own medications and sometimes just refused to order or could not afford the payments, Page 8 of 13 = a re NY ma 19, That the Agency determined this deficient practice was telated to the personal care of the residents that indirectly or potentially threatened the health, safety, or security of the residents and cited Respondent for a State Class mw deficiency violation. 20. That the Agency provided Respondent with a mandatory correction date of August 13, 2010, . , 21. That on August 30, 2010, the Agency conducted a re-visit to the Complaint Investigation Survey (CCR No. 2010005790) of Respondent’s facility, ee ce 22,— ‘That-based-on-record-review-and-interview,-Respondent’s-facility-did-not-make-every———_—_— reasonable effort to ensure that prescription were filled or refilled in a timely manner for four (4) of ten (10) sampled residents who received assistance with self-administration of medications, specifically, Resident No, 6, Resident No. 8, Resident No. 9 and Resident No. 10, hereafter “R6”, “RB”, “RO”, and “R10”. - . 23. That with respect to R6: a. R6 record review on 08/30/10 at approximately 11:00 ‘4M revealed an 1823 dated 05/04/09 with diagnoses of GERD (reflux disease) and DJD (joint disease). b. The August 2010 MOR listed Gas-X, 80 mg., one (1) three (3) times daily at 8:00 AM, 12:00 PM and 4:00 PM (before meals) and had staff initials circled from 08/26/10 through 8/29 for all three (3) dosages and on, 8/30 at 8:00 AM. Entries _ ‘on the back of the MOR indicated that the Gas-X (an over the counter medication) was “not available, waiting on family”. 24. — That with respect to R8: a. R8 had an 1823 dated 04/13/09 that indicated dingnoses of DM (diabetes), HTN + (high blood pressure) and schizophrenia and assistance was needed with medications. Page 9 of 13 LN — b. The August 2010 MOR listed Coreg 12.5 mg one (1) twice daily at 8:00 AM and — 5:00 PM.. Staff initials were circled on: i) 8/23 at 8:00 AM and from 8/24 at 8:00 AM and 5:00 PM through " 8/29; ii) Entries on the back of the MOR indicated “awaiting delivery”: hid Amaryl 4 mg one (1) twice daily at 8:00 AM and 5:00 PM had staff initials circled from 8/24 at 8:00 AM and 5:00 PM through the Amaryl was “not available”, iv) Norvase 10 mg one (1) daily had staff initials circled from 8/24 to 08/29/10, The entries on the back of the MOR indicated that the Norvase was “not given awaiting delivery”, 25. That with respect to R9: a, R9 had an 1823 dated 04/13/09 that indicated diagnoses of DM, HTN, CVA and seizures and assistance was needed with medications. , b, The August 2010 MOR listed Lovastatin 40 mg one (1) at bedtime and had staff initials citcled from 8/15 until 08/23/10. Entries on the back of the MOR indicated that the Lovastatin was “not available, wife did not bring, wife will bring on 8/22”, 26. That with respect to R10: a. R10 had an 1823 dated 07/15/08 that indicated diagnoses of DM, CAD and left . sttoke hemiparesis and assistance was needed with medications. b. The August 2010 MOR listed Lasix 40 mg one (1) daily for seven (7) days at bedtime per physician’s order dated 08/25/ 10, The MOR had a hand written line Page 10 of 13 " drawn actoss-8/1 to 8/28; staff initials were circled on 8/29 and 08/30/10. Entries on the back of the MOR indicated that the Lasix was “not available - account frozen with pharmacy”. On 8/29 and 8/30 was “riot available- account frozen-will deliver”, That continued review revealed no notations that confirmed what measures Respondent’s facility took to ensure that the pattern of unavailable medications was resolved. Respondent’s facility had no evidence to confirm what efforts were made to obtain medications and refills, i [aah nut fearon sepa rm bonne provides conta ona eel amlegg i a Pr agencies for additional medication coverage. That Respondent’s Nursing Supervisor claimed Respondent's facility tried hard to ensure medications were available and they had no’ control over families. That the above reflect, inter alia, that Respondent consistently failed or refused to make every effort to ensure that prescription wete filled or refilled in a timely manner for Respondent’s residents, contrary to-law, That Respondent failed or refused to take action to correct the deficient practice despite a. previous citation for the violation. See § 429,19(3)(c), Fla. Stat. (2010), That the Agency determined this deficient practice was related to the personal care of the residents that indirectly or potentially threatened the health, safety, or security of the residents and cited Respondent for an uncorrected State Class III deficiency violation. That the same constitutes grounds for an uncortected Class II deficiency violation as WHEREFORE, the Agency intends to impose an administrative fine in the amount of five hundred dollars ($500.00), against Reepondent, an ALF in the State of Florida, pursuant to Section § 429.19(2)(c), Fla. Stat, (2010). Page 11 of 13 ate a a COUNT IE "33. The Agency re-alleges and incorporates the entitely of this complaint as if fully set. forth herein, 34, — That pursuant to § 429.19(7), Fla. Stat. (2010), “{ijn addition to any administrative fines imposed, the agency may assess a survey fee, equal to the. lesser of one half of the facility's biennial license and bed. fee or $500, to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint or 35. That pursuant to § 429.19(7), Fla. Stat. (2010), such a finding subjects the Respondent to a survey fee equal to the lesser of one half of the Respondent's biennial license and bed fee or five hundred dollars ($500,00). 36. That Respondent is therefore subject to a complaint survey fee of five hundred dollars ($500.00), pursuant-to § 429.19(7), Fla. Stat, (2010), WHEREFORE, the Agency intends to impose an additional survey fee of five hundred dollars ($500.00) against Respondent, an ALF in the State of Florida, pursuant to § 429,19(7), ’ Fla, Stat. (2010). Respectfully submitted this 15 day of December, 2010, - ‘ STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION The Sebring Building 525 Mirror Lake Dr. N., Suite 330 St. Petersburg, Florida 33701 Telephone: (727) 552-1942 Facsimile: (727) 552-4440 E-mail: Thomas. A; (@ahea.myflorida.com By: Thonfas F. Asbury, Esq. Fla. Bar No. 567523 ’ Page 12 of 13 oe “ 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 Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, FL 52308; Telephone (850) 412-3630, 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 FINA ORDER BY THE-AGENCY; CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has begn served by U.S. Certified Mail, Return Receipt No. 7001 0360 0003 3808 3413 on December 1s 2010 to Corporation Services Company, Registered Agent, 1201 Hays Street, Tallahassee, FL 32301- 2525 and via U'S. Mail to Leasa R. Phenix, Administrator, Brookshire ( 85 Bulldog Blvd., ‘Melbourne, Florida 32901. Copies furnished to: Brookshire (The) - Thomas F. Asbury, Esq. ATTN: Leasa R. Phenix, Admin. Agency for Health Care Admin. 85 Bulldog Blvd, . | 525 Mirror Lake Dr. N., 330 Melbourne, Florida 32901 St, Petersburg, Florida 33701 (U.S. Mail) (Interoffice) Theresa DeCanio Brookshire (The) (Interoffice) ATIN: Corporation. Services Company, Reg. Agent , 1201 Hays Street Tallahassee, FL 32301-2525 (U.S. Certified Mail) - Page 13 of 13 USPS - Track & Confirm . ) Page | of I Track & Confirm Search Results Label/Raceipt Number: 7001 0360 0003 3808 3413 Service(s); Certified Mail™ Status: Delivered Your item was delivered at 9:30 am on December 20, 2010 In TALLAHASSEE, FL 32314. : Detailed Results: * Delivered, December 20, 2010, 9:30-am, TALLAHASSEE, FL 32314 * Arrival at Unit, December 20, 2010, 7:06 am, TALLAHASSEE, FL 32301 HMotfioation Opt enero snntnninannmnnununininanneninmannneimn mae Track & Confirm by amall . . : Get current event Information or updates for your item sent to you or others by email. 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Docket for Case No: 11-000561