STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, FILED Rineas COO anes DS Ao MENT CLERK Petitioner, AHCA NO: 2001059391 vs. o GULF CARE, INC., d/b/a, wi ~~ GULF COAST VILLAGE CARE CENTER 2) be Respondent. a / Bos Ve) 2 - ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, “Respondent”) and alleges: and files this Administrative Complaint against GULF CARE, INC d/b/a, GULF COAST VILLAGE CARE CENTER, (hereinafter ‘ 1. Nature of the Action dollars ($4000) and (d) pursuant to Sections 400.23(8) (b) and (c) This is an action to impose a fine of four thousand 400.102 (1) (a) 2. and The Respondent was re-cited for the deficiency during the Complaint Investigation re-visit survey conducted on or about September 24, 2001. The deficiencies were originally cited in a survey conducted on or about August 7, 2001 and August 21, 2001. Jurisdiction and Venue 3. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. 4. Venue lies in Lee County, Division of Administrative Hearings, pursuant to 120.57 Florida Statutes, and Chapter 28, Florida Administrative Code. Parties 5. AHCA, is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part II, Florida Statutes and Rules 59A-4, Florida Administrative Code. 6. Respondent is a nursing home located at 1333 Santa Barbara Boulevard, Cape Coral, FL 33991. The facility is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I RESPONDENT FAILED TO PROVIDE EACH RESIDENT WITH ADEQUATE AND APPROPRIATE CARE; AND FAILED TO PROVIDE NECESSARY CARE AND SERVICES TO ATTAIN HIGHEST PRACTICABLE WELL-BEING BY ADMINISTERING AN UNNECESSARY DRUG VIOLATING SECTION 400.022(1) (1), F.S. AND RULE 59A-4.1288, F.A.C. ADOPTING BY REFERENCE 42 CFR § 483.25(1) CLASS III DEFICIENCY 7. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 8. Based on record review and interview it was determined that Respondent failed to assure that one of four (resident #5) resident’s drug regimen had appropriate indications for the routine use of an anxiolytic medication and that the resident was adequately monitored through the use of behavior monitoring records. The record indicates a physician order from January 16, 2001 for Alprazolam (Xanax) 0.25mg take 1 tablet by mouth (PO) three times a day (TID) as needed (PRN) for anxiety. Record review revealed the resident received 49 out of 273 (17.93%) dosing opportunities in April, May and June. A review of the June Behavior Monitoring Sheet revealed that the Respondent was monitoring the resident for Paranoia and that the Respondent did not record any such behaviors for that month. A Physicians Progress note indicates due to the resident being lethargic the Xanax should be reduced to twice a day. Respondent failed to produce the resident’s August and September behavior monitoring sheet when surveyor asked for it. When interviewed about the resident’s chart, the Director of Nurses (DON) could not find any indications of anxious behavior prior to increasing the Xanax from as needed to routine three times a day or prior to making the medication routine on July 2, 2001. 9. This is a violation of Section 400.022(1) (1), Florida Statutes which requires Respondent to ensure resident receives adequate and appropriate care; and Rule 59A-4.1288, Florida Administrative Code adopting by reference 42 C.F.R. § 483.25(1) which requires each resident must receive and the Respondent must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care and to must be free from unnecessary drugs including an excessive dose. 10. Based on the foregoing, this is a Class III deficiency pursuant to Section 400.23(8) (c), Florida Statutes. 11. The Agency seeks to impose a fine of two thousand dollars ($2000) for this Class III deficiency as authorized under Sections 400.23(8) (c) and 400.102(1) (a) and (d), Florida Statutes. This violation was first cited on August 7, 2001 at a (S/S-G) Class II deficiency. The deficiency remained uncorrected on September 24, 2001, resulting in citation at (S/S-D) Class III deficiency. The fine amount of $1000 is doubled due to the uncorrected Class II deficiency. COUNT II RESPONDENT FAILED TO MAINTAIN AN INFECTION CONTROL PROGRAM TO PROVIDE A SAFE AND SANITARY ENVIRONMENT VIOLATING RULE 59A-4.106(4) (1), F.A.C. and 59A-4.1288, F.A.C. INCORPORATING BY REFERENCE 42 C.F.R § 483.65 (a) CLASS III DEFICIENCY 12. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 13. Based on record review, observations and interview it was determined that Respondent failed to implement procedures to prevent recurrence for infection for one (resident #4) of four sampled residents reviewed for infection control. Respondent failed to practice infection control procedures for resident #4. Residnet #4 was admitted to facility on April 9, 2001 with a diagnoses that included Hemorraghic Cystitis, MRSA (Methicillin Resistant Staphylococcus Aureus, UTI (Urinary Tract infection) and SDAT (Senile Dementia Alzheimer’s Type). During the initial tour on 9/24/01 at approximately 9:30 A.M., the nurse stated that the resident has a history of infection on her PEG tube site and also history of UTI. She confirmed the resident requires total care. Observation of the resident revealed she is alert but incoherent. Surveyor observed resident sitting in a Geri-lounge chair with her lower extremities elevated. Respondent’s PEG tube is connected to a Jevity feeding infusing at 75 cc/hr through a pump. The tubing which is connected to her PEG tube from the Jevity feeding did not have a date on the label to indicate when it was changed. Further observation revealed an enteral bag with tubing hanging next to the Jevity feeding. The bag was approximately a quarter full of water. The label on the bag was dated "9/21/01". Observation of the PEG tube connector (the end that is connected to the PEG tube) at the end of the tubing of the bag revealed it was not covered and exposed to air. Review of resident’s clinical record revealed results of culture and sensitivity from the resident’s PEG site of: 7/7/01 - 3+ growth Pseudomonas Aeruginosa; very few colonies of mixed skin microflora; The physician ordered Cipro (antibiotic) 250 mg. one tablet twice a day for 10 days. - 7/20/01 - 2+ growth Pseudomonas Species.; - 2+ growth Proteus Mirabilis.; The physician ordered Levaquin 500 mg. one tablet everyday for 10 days.; - 8/6/01 - 1+ growth Serratia Marcesns; very few colonies of Pseudomonas Aeruginosa.; - 1+ growth Candida Albicans - presumptive identification.; The physician ordered treatment of the PEG site with Silvadene ointment after cleansing with normal saline then wipe with 25% Betadine twice a day. During the review of the facility's policy and procedure on infection control it stated, "35. Open unused enteral feedings and/or supplements are labeled with the time and date of opening and are covered and refrigerated; 37. Gavage equipment is changed every 24 hours (bag, bolus, syringe and tubing) ." During an interview with the DON (Director of Nursing) on 9/24/01 at approximately 10:50 A.M., she confirmed that the tubings and enteral bags must be labeled and changed every 24 hours. There was no explanation why the enteral bag with water was not changed since 9/21/01. 14. This is a violation of Section 400.022(1) (1), Florida Statutes which requires Respondent to ensure resident receives adequate and appropriate care; Rule 59A-4.106(4) (1), Florida Administrative Code which requires Respondent to maintain policies and procedures in area or infection control; and 42 C.F.R § 483.65(a) which requires the facility to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection. The infection control program must investigate, control and prevent infection, procedures, and maintain records or incidents and corrective action related to infections. 15. Based on the foregoing this is a Class III deficiency pursuant to Section 400.23(8) (c), Florida Statutes. 16. The Agency seeks to impose a fine of two thousand dollars ($2000) for this Class III deficiency as authorized under Sections 400.23(8)(c) and 400.102(1) (a) and (d), Florida Statutes. This violation was first cited on August 21, 2001 at a (S/S-F) Class III deficiency. The deficiency remained uncorrected on September 24, 2001, resulting in citation at (S/S-D) Class III deficiency. The fine amount of $1000 is doubled due to uncorrected Class II deficiency of August 7, 2001. WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Count I and Count II; B. Impose a fine of two thousand dollars ($2000) for the violation cited in Count I, and two thousand dollars ($2000) for the violation cited in Count II for a total of four thousand dollars ($4000) against the respondent under Sections 400.23(8) (b) and (c), 400.102(1) (a) and (da), Florida Statutes; Cc. Reasonable attorney’s fees and costs; and D. 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 Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the Care Administr ation, 525 Mirror Lake Dr. N., St. Petersburg, Florida, 33701. 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. pun X H&anis Godfrey, Esqui AHCA - Senior Attornéy FBN: 0158100 525 Mirror Lake Drive North, St. Petersburg, Florida 33701 (727) 552-1525 I HEREBY CERTIFY that a true copy hereof has been sent by U.S. Certified Mail Return Receipt No. 7099 3400 0002 2450 8146, to the Registered Agent for GULF CARE, INC., d/b/a, GULF COAST VILLAGE CARE CENTER, Richard C. Heath, at 1333 Santa Barbara Boulevard, Cape Coral, FL 33991, and by prepaid U.S. Mail to Administrator GULF COAST VILLAGE CARE CENTER, 1333 Santa Barbara Boulevard, Cape Coral, FL 33991, on the 15° day of May, 2002. Dennis L. Godfrey, Esquyte Copies furnished to: Registered Agent for GULF CARE, INC., d/b/a, GULF COAST VILLAGE CARE CENTER: Richard C. Heath 1333 Santa Barbara Boulevard Cape Coral, FL 33991 (Certified Mail) Administrator GULF COAST VILLAGE CARE CENTER 1333 Santa Barbara Boulevard Cape Coral, FL 33991 (U.S. Mail) Dennis L. Godfrey AHCA ~ Senior Attorney 525 Mirror Lake Drive Suite 3107 St. Petersburg, Fl 33701

Docket for Case No: 02-002496