STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, v. AHCA CASE NO. 2001076511 EDENGARDENS -GAINESVILLE, L.P., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “Agency”), by and through its undersigned counsel, and files this Administrative Complaint against EDENGARDENS - GAINESVILLE, L.P. (hereinafter “Edengardens”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2001), and alleges the following: Nature of the Action 1. This is an action to impose a $3,500.00 administrative fine against Edengardens pursuant to Sections 400.414(1) (e), 400.419(1) (b), and 400.419(3), Florida Statutes, based on three (3) class II deficiencies and to impose a $500.00 survey fee against Edengardens pursuant to Section 400.419(9), Florida Statutes. Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. The Agency has jurisdiction over Edengardens pursuant to Chapter 400, Part III, Florida Statutes. 4. Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code. Parties 5. Pursuant to Chapter 400, Part III, Florida Statutes, and Chapter 58A-5, Florida Administrative Code, the Agency is the licensing and enforcing authority with regard to assisted living facility laws and rules. 6. Edengardens-Gainesville, L.P., is a foreign limited partnership with a principal address of 10 Roswell Street, Suite 200, Alpharetta, Georgia 30004. 7. Edengardens is an assisted living facility located at 1415 Fort Clarke Boulevard, Gainesville, Florida 32606. Edengardens is and was at all times material hereto a licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code, having been issued license number AL9815 by the Agency (certificate number # 12300) with an effective date of April 5, 2002, and an expiration date of March 29, 2004 and an extended congregate care designation. COUNT I EDENGARDENS FAILED TO ENSURE THE PROVISION OF ADEQUATE CARE TO RESIDENTS IN ITS FACILITY. Section 400.428(1)(b), Fla. Stat. (2001) Rule 58A-5.019(1), Fla. Admin. Code (2001) CLASS II DEFICIENCY 8. The Agency re-alleges and incorporates by reference paragraphs one (1) through seven (7) above as if fully set forth herein. 9. On or about August 31-September 3, 2001, the Agency performed a survey at Edengardens. Based on surveyor observations, staff interviews and record reviews, the Agency cited Edengardens for a class II deficiency based on the findings below. 10. Resident #1, a male resident, climbed into bed with other female residents. Resident #1 also became violent on one known occasion and kicked another resident in the pelvic area. Other residents in the facility were afraid of resident #1. li. A nurse’s note dated on or about July 6, 2001, at approximately 10:00 p.m. provided "resident constantly wandering into female residents' rooms climbing into their beds with them. Female residents are afraid of this male resident." 12. On or about August 31-September 3, 2001 an Agency surveyor reviewed resident #3’s medical record. The record contained a statement made on or about July 6, 2001 by this female resident that she was afraid of resident #1 and could not relax. 13. According to Resident #1’s nurse’s note dated on or about July 15, 2001, at approximately 12:20 p.m. "resident #1 had an incident this morning where he for no apparent reason kicked resident #2 in the pelvic area." According to Resident #2’s nurses’ notes dated July 15, 2001, the resident complained of low stomach pain during the 3:00 p.m. to 11:00 p.m. shift. 14. Resident #1's physician was notified of the July 15, 2001 incident. The physician recommended that resident #1's hearing aides be placed in his ears and ordered a medication dosage change. 15. On or about July 15, 2001 the physician changed Resident #1’s prescription for Risperdal from one (1) milligram tablet every day to one (1) milligram tablet twice a day. The directions on resident #1’s medication observation record, however, erroneously provided that the medication was to be administered once a day rather than twice a day as per the physician’s order. Therefore, Resident #1 received only one (1) milligram tablet of Risperdal a day. The active ingredient in Risperdal is Risperidone, which is used to treat psychotic disorders and symptoms such as hallucinations, delusions, and hostility. 16. On or about August 31-September 3, 2001 an Agency surveyor interviewed Edengardens’ Administrator. The interview revealed that the Administrator was unaware of resident #1’s behavior. 17. On or about August 31-September 3, 2001 an Agency surveyor interviewed Edengardens’ direct care staff. The interviews revealed that Edengardens had failed to take actions to control resident #1’s behavior. 18. On or about August 31-September 3, 2001 the Agency surveyor observed resident #1 at various times. The surveyor observed that resident #1 was not wearing his hearing aides as recommended by the resident’s physician. The Agency surveyor interviewed a nurse caring for resident #1. The nurse was unaware that resident #1 wore hearing aids. 19. Based on all of the foregoing, Edengardens has violated: (a) Rule 58A-5.019(1), Florida Administrative Code, by failing to ensure the provision of adequate care to its residents; and (b) Section 400.428(b), Florida Statutes, by failing to ensure that each resident is treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy. 20. The foregoing violation is a class II violation in that it directly threatened the physical or emotional health, safety, or security of Edengardens’ residents. Pursuant to Section 400.419(1) (b), Florida Statutes, the Agency is authorized to impose a fine against Edengardens in the amount of $1,000.00. 21. The facility was given a mandated correction date of September 30, 2001, in accordance with Section 400.419(1) (b), Florida Statutes. 22. In addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one-half (1/2) of the facility’s biennial license and bed fee or $500.00, 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 monitoring visits conducted under Section 400.428 (3) (c) to verify the correction of the violation. 23. Edengardens’ biennial license and bed fee for the 2002-2004 biennium is equal to $6,723.00. 24. Based on the foregoing, Edengardens may assess a $500.00 survey fee against Edengardens pursuant to Section 400.419(9), Florida Statutes. COUNT II ENDENGARDENS FAILED TO MAINTAIN AN ACCURATE DAILY UP-TO-DATE MEDICATION OBSERVATION RECORD FOR EACH RESIDENT. ADDITIONALLY, EDENGARDENS FAILED TO ENSURE THAT EACH RESIDENT’ S MEDICATION OBSERVATION RECORD WAS IMMEDIATELY UPDATED EACH TIME THE MEDICATION WAS OFFERED OR ADMINISTERED TO THE RESIDENT. Rule 58a-5.0185(5) (b), Fla. Admin. Code (2001) CLASS II DEFICIENCY 25. The Agency re-alleges and incorporates by reference paragraphs one (1) through seven (7) above as if fully set forth herein. 26. On or about August 31-September 3, 2001, the Agency performed a survey at Edengardens. Based on surveyor observations, staff interviews and record reviews, the Agency cited Edengardens for a class II deficiency based on the findings below. 27. Edengardens had no system in place to assure that residents received their medications accurately and timely. 28. On or about September 1, 2001 at approximately 3:00 p.m. an Agency surveyor observed the medication observation records for the month of September 2001 for the twenty-two (22) “keepsake” residents in a pile on a table. No morning or afternoon medications had been documented as being given to any of these residents. 29. On or about September 1, 2001 an Agency surveyor interviewed an Edengardens’ nurse. The nurse stated, "the night nurse didn't do the MORs last night." The nurse further stated that she gave each resident his or her day shift medications but she did not update each resident’s medication observation record at the time the medication was offered or administered to the resident. 30. Edengardens’ failure to immediately update each resident’s medication observation record at the time the medication is administered to the resident has caused and/or has the potential to cause future medication errors and omissions. 31. Resident #1 was prescribed Atarax 25mg three (3) times a day as needed for itching on August 30, 2001. The directions had been erroneously transcribed and given as three (3) times a day routinely on the August 2001 medication observation record. Therefore, Edengardens failed to assess resident #1’s need for Atarax prior to each medication administration. 32. Finally, according to Resident #1’s medical record, his order for Risperdal was changed on or about July 15, 2001 from one (1) milligram every day to one (1) milligram twice a day. The directions on resident #1’s medication observation record, however, erroneously provided that the medication was to be administered once a day rather than twice a day as per the physician’s order. 33. Based on all of the foregoing, Edengardens has violated Rule 58A-5.0185(5) (b), Florida Administrative Code, by failing to ensure that each resident’s medication observation record is immediately updated each time the medication is offered or administered and by failing to ensure that each resident’s medication observation record was accurate and up-to- date. 34. The foregoing violation is a class II violation in that it directly threatened the physical or emotional health, safety, or security of Edengardens’ residents. Pursuant to Section 400.419(1) (b), Florida Statutes, the Agency is authorized to impose a fine against Edengardens in the amount of $1,000.00. 35. The facility was given a mandated correction date of September 30, 2001, in accordance with Section 400.419(1) (b), Florida Statutes. 36. In addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one-half (1/2) of the facility’s biennial license and bed fee or $500.00, 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 monitoring visits conducted under Section 400.428(3) (c) to verify the correction of the violation. 37. Edengardens’ biennial license and bed fee for the 2002-2004 biennium is equal to $6,723.00. 38. Based on the foregoing, Edengardens May assess a $500.00 survey fee against Edengardens pursuant to Section 400.419(9), Florida Statutes. COUNT III EDENGARDENS FAILED TO PROVIDE CARE AND SERVICES APPROPRIATE TO THE NEEDS OF RESIDENTS ACCEPTED FOR ADMISSION TO THE FACILITY. Section 400.428(1) (a), Fla. Stat. (2001) Rule 58a-5.0182, Fla. Admin. Code (2001) CLASS II DEFICIENCY 39. The Agency re-alleges and incorporates by reference paragraphs one (1) through seven (7) above as if fully set forth herein. 40. On or about August 31-September 3, 2001, the Agency performed a survey at Edengardens. Based on surveyor observations, record reviews and staff interviews, the Agency cited Edengardens for a class II deficiency based on the findings below. 41. Resident #3 and resident #1 each sustained numerous ant bites at Edengardens on two (2) separate occasions. On or July 9, 2001 Resident #3 was bitten by numerous ants while in her bed at Edengardens. On or about August 30, 2001 resident #1 sustained about one hundred (100) ant bites while in his bed at Edengardens. 10 Resident #3 42. On or about July 9, 2001 at approximately 10:00 a.m. Resident #3’s caregiver discovered Resident #3 soaked in urine with multiple ant bites. According to the nurses’ notes, a nurse observed ants on resident #3's sheets and bedspread. 43. Although Edengardens sprayed resident #3’s room, Edengardens failed to immediately contact a professional pest control company to address the severe fire ant problem in the facility. Edengardens failed to address the fire ant problem after the incident on or about July 9, 2001. This failure resulted in another fire ant incident on or about August 30, 2001 involving resident #1. Resident #1 44. On or about August 30, 2001 at approximately 2:50 p-m., Edengardens’ direct care staff found resident #1 with approximately one hundred (100) ant bites on his body. According to the nurses’ notes, the resident had "long, brownish red ants all over his bed" and "multiple lesions red, swollen, pus filled (white pus) on neck, right arm, front and back, waist, right back, chest and both hips." 45. On or about August 31-September 3, 2001 an Agency surveyor observed Resident #1. Resident #1 gave the Agency surveyor permission to inspect his body. His upper torso remained covered with red marks and white pustules. Forty-six 11 (46) pustules remained on his right arm and right side of neck. Four (4) were on the front of his neck and twenty-two (22) on his right upper hip. Several more bites were scattered on his left hip. 46. On or about August 31-September 3, 2001 an Agency surveyor interviewed Edengardens’ Administrator, Maintenance Director and a representative of the pest control company under contract with the facility. The interviews revealed that the pest control company treated the inside and outside of the building on or about, respectively, August 30 and 31, 2001. However, the contract by and between Edengardens and the pest control company did not include “carpenter ants, fire ants or Pharaoh ants”. The Maintenance Director stated that Edengardens had a lawn service company but he was unable to advise as to whether this company was responsible for the eradication of outside fire ant nests. In fact, Edengardens failed once again to eradicate the fire ant problem as evidenced below. 47. On or about August 31, 2001 at approximately 7:30 p.m. the Agency surveyor observed ants in Edengardens’ laundry room. On or about September 1, 2001 at approximately 10:00 a.m. an Agency surveyor observed twelve (12) fire ant nests on the lawn beneath resident #1's window. The surveyor further observed three (3) more fire ant nests three (3) feet beyond the twelve (12) nests located below resident #1’s window. On or about September 3, 2001 at approximately 1:00 p.m. the Agency surveyor observed ants in Edengardens’ Wellness Room. 48. Edengardens failed to provide care and services appropriate to the needs of the residents in the facility by failing to eradicate the fire ant problem in its facility and by failing to be aware of the general health, safety, and physical and emotional well-being of the residents in its facility. 49, Edengardens further failed to provided care and services appropriate to resident #1’s needs by failing to ensure that he was receiving his medication accurately and by failing to assess his needs upon becoming aware of changes in his behavior or mood. 50. On or about August 31-September 3, 2001 an Agency surveyor interviewed an Edengardens’ nurse regarding resident #1. The nurse stated, "after his medication was doubled when he kicked that woman in July he has been sedated and lethargic and groggy.” The surveyor interviewed another Edengardens’ nurse who stated that for the last several days resident #1 walked much slower, he sat with his head hanging down, he seemed groggy. 51. On or about August 31-September 3, 2001 an Agency surveyor reviewed resident #1’s record. On or about August 29, 2001 a nurse documented on his medication record that he was 13 "very sedated." A second nurse documented that, "he has been lethargic the last two days." 52. On or about August 31-September 3, 2001 the Agency surveyor observed resident #1 sitting in the dining area slumped forward with his head hanging against the wooded balustrade. He required an aide to assist him with walking. White pustules remained visible on the right side of his neck. 53. On or about September 3, 2001 at approximately 11:30 a.m. Edengardens’ direct care staff found Resident #1 lying on the floor. Resident #1 was transported to a hospital emergency room for evaluation. 54. After being bitten by fire ants, Resident #1’s physician prescribed one 25 milligram tablet of Atarax three (3) times a day as needed for itching. The directions had been erroneously transcribed onto the August 2001 medication observation record as three (3) times a day routinely. Due to this error, Edengardens failed to assess Resident #1’s need for Atarax prior to each administration of the medication. By failing to do these assessments, Edengardens failed to provide services and care appropriate to resident #1’s needs. A side effect of Atarax is drowsiness. 55. Finally, on or about August 31, 2001 at approximately 12:00 p.m. an Agency surveyor observed a chair on the facility's lawn with a broken leg. This chair could be dangerous if a 14 resident attempted to sit on it. The Agency surveyor brought this matter to the attention of Edengardens’ administrative staff. However, a few days later on or about September 3, 2001 at approximately 12:30 p.m. the Agency surveyor observed that the broken chair was still on the facility’s lawn. 56. Based on all of the foregoing, Edengardens has violated: (a) Rule 58A-5.0182, Florida Administrative Code, by failing to provide care and services appropriate to the needs of residents accepted for admission to its facility; and (b) Section 400.428(1) (a), Florida Statutes, by failing to ensure that each resident has the right to live in safe and decent environment, free from abuse and neglect. 57. The foregoing violation is a class II violation in that it directly threatened the physical or emotional health, safety, or security of Edengardens’ residents. Pursuant to Section 400.419(1) (b), Florida Statutes, the Agency is authorized to impose a fine against Edengardens in the amount of $1,000.00. 58. The facility was given a mandated correction date of September 30, 2001, in accordance with Section 400.419(1) (b), Florida Statutes. 59. In addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one-half (1/2) of the facility’s biennial license and bed fee or $500.00, 15 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 monitoring visits conducted under Section 400.428(3) (c) to verify the correction of the violation. 60. Edengardens’ biennial license and bed fee for the 2002-2004 biennium is equal to $6,723.00. 61. Based on the foregoing, Edengardens may assess a $500.00 survey fee against Edengardens pursuant to Section 400.419(9), Florida Statutes. CLAIM FOR RELIEF REE WHEREFORE, the Agency respectfully requests the following relief: 1) Make factual and legal findings in favor of the Agency on Counts I, II, and III; 2) Impose a fine against Edengardens in the amount of $3,000.00 pursuant to Sections 400.414 (1) (e) and 400.419(1) (b), Florida Statutes; 3) Impose a $500.00 survey fee against Edengardens pursuant to Section 400.419(9), Florida Statutes; and 4) Grant any other general and equitable relief as deemed necessary in the furtherance of justice. 16 NOTICE Edengardens hereby is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to Lori Cc. Desnick, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida, 32308. EDENGARDENS IS FURTHER NOTIFIED THAT THRE FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT oF THIS ADMINISTRATIVE COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE ADMINISTRATIVE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, Lori C. Desnick Senior Attorney Florida Bar No. 0129542 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 (850) 921-0071 (850) 921-0158 (fax) CERTIFICATE OF SERVICE SE ERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint has been sent by U.S. Certified Mail, Return Receipt Requested, (Return Receipt # 7106 4575 1294 2049 9405) to Mark Kane, Administrator, Edengardens-Gainesville, L.P., 1415 Fort Clarke Boulevard, Gainesville, Florida 32606 and (Return Receipt # 7106 4575 1294 2049 9399) to c.7. Corporation System, Registered Agent, Edengardens-Gainesville, L.P., 1200 South Pine Island Road, Plantation, FL 33324 on this 24th day of June 2002. LORI C. DESNICK, ESQUIRE

Docket for Case No: 02-003258