STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION JON da pe STATE OF FLORIDA ris ; AGENCY FOR HEALTH De. AATMENERLERK , CARE ADMINISTRATION, » vat Petitioner, on AHCA NO:..-260104 eal See $351". vs. GULF CARE, INC., d/b/a, GULF COAST VILLAGE CARE CENTER Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against GULF CARE, INC., d/b/a, GULF COAST VILLAGE CARE CENTER, (hereinafter “Respondent”) and alleges: Nature of the Action 1. This is an action to impose a fine of two thousand five hundred dollars ($2500) pursuant to Sections 400.23(8) (b) and 400.102(1) (a) and (d). 2. The Respondent was originally cited for the deficiency during the survey conducted on or about August 7, 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 HEALTH 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 II DEFICIENCY 7. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 8. Based on record review, observations and interview it was determined that Respondent failed to prevent the administration of an ACE inhibitor medication for one (resident #2) of three sampled residents at four times the prescribed dose for one resident. This was done without adequate care and monitoring resulting in the resident experiencing signs of adverse reaction. Resident #2 is 92 years old. Upon admittance, the Patient Transfer and Continuity of Care form accompanying her listed Mavik as one of the five medications for the resident to receive in a dose of 2mg PO (by mouth) QD (everyday). Mavik is an ACE Inhibitor given for hypertension (elevated blood pressure). Respondent misread and then incorrectly documented the order for resident #2’s Mavik to be QID (four time a day). The facility physician (the Medical Director) documented his agreement with the four times a day Mavik on June 12, 2001. The Medication Administration Record (MAR) documents the Respondent gave Mavik four times a day while resident #2 was in the facility. Interview with resident #2’'s family revealed the resident was lethargic, nauseated, weak, and complained of chest pain and looked “jaundiced.” Resident #2 was readmitted to hospital on June 18, 2001 Upon admission to the hospital the admitting physician documented in the History and Physical (H&P) the resident had “Hyponatremia, most likely secondary to Mavik. The patient is receiving an inappropriately high dose of Mavik 2 mg QID.” The resident is noted to have a Na (sodium) level of 117 on readmission. The H&P further indicates “The patient was discharged on June 12, 2001 with a sodium level of 135 (normal 135-140).” Medical treatment included “discontinue Mavik and cautious intravenous fluids.” Resident was discharged on June 22, 2001 from hospital to a different facility. She died within a few days. 9. This is a violation of Section 400.022(1) (1), Florida Statutes which requires Respondent to ensure resident receives adequate and appropriate health 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 must be free from unnecessary drugs including an excessive dose. 10. Based on the foregoing this is a Class II deficiency pursuant to Section 400.23(8) (b), Florida Statutes. 11. The Agency seeks to impose a fine of two thousand five hundred dollars ($2500) for this Class II deficiency as authorized under Sections 400.23(8) (b) and 400.102(1) (a) and (d), Florida Statutes. WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Count I; B. Impose a fine of two thousand five hundred dollars ($2500) for the violation cited in Count I, against the respondent under Sections 400.23(8) (b), 400.102(1) (a) and (dad), 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 attention of Dennis Godfrey, Senior Attorney, Agency for Health Care Administration, 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. Respectfully submitted, ennis Godfrey, Es re AHCA - Senior Attorhey 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. 7001 2510 0007 5976 5308, 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 g Y gay of May, 2002. Dennis ee Copies furnished to: Richard C. Heath Registered Agent for GULF COAST VILLAGE CARE CENTER: 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 Godfrey AHCA - Senior Attorney 525 Mirror Lake Drive Suite 3107 St. Petersburg, Fl 33701

Docket for Case No: 02-002499