68/12/2982 19:88 8584745; 35 THE HEALTH CENTEN STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION “ AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2002042251 THE HEALTH CENTER OF PENSACOLA, INC. d/b/a THE HEALTH CENTER OF PENSACOLA, The Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against TEE HEALTH CENTER OF PENSACOLA, INC. d/b/a THE HEALTH CENTER OF PENSACOLA (“Respondent”), pursuant to sections 120.569, and 120.57, Florida Statutes, and alleges: NATURE OF THE ACTION 1 This is an action to impose an administrative fine in the amount of $4,000 against THE HEALTH CENTER OF PENSACOLA, INC. d/b/a THE HEALTH CENTER OF PENSACOLA, pursuant to Section 400.102, Florida Statutes. JURISDICTION AND VENUE @B/12/2682 19:68 8504749 +45 THE HEALTH CENTER PAGE 12/21 2. This tribunal has jurisdiction pursuant to sections 120.569 and 120.57, Florida Statutes. 3. Venue shall be determined pursuant to Rule 28- 106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory agency responsible for licensure of nursing homes and enforcement of all applicable federal regulations, state statutes and rules geverning skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title Iv, Subtitle c (as amended); Chapter 400, Part II, Florida Statutes, and; Chapter S9A-4 Fla. Admin. Code, respectively. 5. Respondent is a skilled nursing facility in the State of Florida, whose 180-bed nursing home is located at 8475 University Parkway, Pensacola, Florida 32514. Respondent is licensed as a skilled mursing facility license #SNF14130961; certificate number 8694, effective June 4, 2002. Respondent was at all times material hereta, @ licensed facility under the licensing authority of ABCA, and was required to comply with all applicable regulations, statutes and rules. Count 1 THE FACILITY PAILED TO LABEL DrRUcS ANT BXOLOGICALS In ACCORDANCE WITH CURRENTLY ACCEPTED PROFESSIONAL PRINCIPLES, AND INCLUDE THE APPROPRIATE. ACCESSORY AND CAUTIONARY INSTRUCTIONS, AND THE EXPIRATION DATE WHEN APPLICABLE. 98/12/2982 19:46 8504749 /95 THE HEALTH CENTER PAGE 42 CFR 483.60(p); Section 400,102(p), FLA. Star.; Section 400.23(8) (c), PLa. Star., ano; RULE S9A-4.112(5), Fna. ApMIN. CopE 6. AHCA re-alleges and incorporates by reference paragraphs (1) through (5) as if fully set forth herein. 7. AHCA surveyors conducted surveys of Respondent's facility between April 29, 2002 and May 3, 2002 and again on June 4, 2002. Staff interview, record review and surveyor observation brought to light the following: a. The following observations were made during the April 29 - May 3, 2002 survey: 1. During medication pass on 4/29/02, the nurse was observed preparing 8 units of NPH insulin and 10 units of Regular insulin to administer to Resident #28. The nurse withdrew the insulin from another resident’s vials. 2. During medication pass on 4/30/02 the nurse was observed preparing 1 unit Albuterol and Lounit Atrovent for Resident #29. The label read % unit Albuterol and 4% unit Atrovent. The nurse explained the order had been changed but the label had not. bh. The following observations were made during the June 4, 2002 survey: 3 13/21 48/12/2882 19:80 8504749 45 THE HEALTH CENTEr PAGE 14/21 1. Observation of the medication carts revealed that four vials of insulin were opened without an open date written on the insulin vial. 2.Miacalcin spray was also unlabeled. 3. Further ingpection showed that four vials of insulin were opened more than 28 days ago. All contained labels with the statement “exp. After 28 days.” 8. Respondent’s failure to label drugs and biologicals in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable, is a violation of 42 CFR 483.60(d). 9. Respondent’s failure to label drugs and biologicals in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable, is a violation of Rule 59A-4.112(5), Fla. Admin. Code. 10. Respondent’s failure to label drugs and biologicals in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable, is a repeat clasa III deficiency as QB/12/2862 19:84 858474d9/45 THE HEALTH CENTEw PAGE 15/21 defined in section 4090.23(8)(c), Fla. Stat. 11, The above constitutes grounds for the imposition of an administrative fine of $2,000 pursuant to section 400.102(d), Fla. Stat. Count rt THE FACILITY FAILED TO FULLY IMPLEMENT THE INFECTION CONTROL PROGRAM THEREBY PREVENTING THE POSSIBLE SPREAD OF INFECTIONS FOR 2 oF 4 WINGS. 42 CFR 483.65 (a) (1) -(3); SECTION 400.102(p), FRA. Stav.; SECTION 400.23(8) (c), FuA. STAT., AND; RULE 59A8-4.106(4) (Lb), FLA. ApMIN. Cope 12. AHCA re-alleges and incorporates by reference paragraphs (1) through (11) as if fully set forth herein. 13. AHCA surveyors conducted surveys of Respondent’s facility between April 29, 2002 and May 3, 2002 and again on June 4,.2002. Staff interview, record review and surveyor observation brought to light the following: a. The following observations were made during the April 29 - May 3, 2002 survey: 1, During medications pass observation revealed soiled enteral pumps with dried liquid food in rooms 261 and 262. The medication cart was soiled with dried liquid medication. 2. Medication pass on the D Wing on 4/30/02 revealed a medication cart soiled with dried Q8/12/ 2882 19:48 8504749 795 THE HEALTH CENTER PAGE 16/21 liquid medication. 3. Medication pass on 4/29/02 showed a nurse giving subcutaneous injection to a resident without wearing gloves. 4. Observation on 4/29/02 at 5:15 pm revealed a nurse checking residuals from a gastronomy tube, administering medications and flushing the tube without wearing gloves. S.On 5/2/02 observed showed a nurse caring for an incontinent resident without gloves. The nurse turned and folded the soiled pad beneath the resident without gloves as well. b. The following observations were made during the June 4, 2002 survey: 1. Room #247 contained a cracked water pitcher Lia. 2. Room #223 had a nasal cannula placed on top of a condenser with no bag protecting the cannula from contamination. Also noted on the bedside table was a used glove. 3. Room #2618 had a bedside table that had dried residue across the entire top of the table. 4.In room #260, a syringe in a plastic bag was found to be hanging beside the enteral pump. 6 88/12/2082 19:08 8584745 °95 THE HEALTH CENTER PAGE 17/21 The beg was undated. 5. In room #349B, approximately 1 inch of water was observed to be in an open unlabeled syringe container on the bedside table of a bolus feeding PEG tube resident. 14. Respondent’s failure to fully implement the infection control program is a violation 42 CFR 483.65 (a) (1) - (3), 15. Respondent’s failure to fully implement the infection control program is a violation of Rule 59A- 4.106(4) (1), Fla. Admin. Code. 16. Respondent's failure to fully implement the infection control program ig a repeat class III deficiency as defined in section 400.23(8)(c), Fla. Stat. 17. The above constitutes grounds for the imposition of an administrative fine of $2,000 pursuant to section 400.102(d), Fla. Stak. CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief: 1). Factual and legal findings in favor of the Agency on Counts I and II, and; 2). Imposition of a $4,000 administrative fine. 98/12/2882 19:a8 8584744 "95 THE HEALTH CENTER PAGE 18/21 Respondent is notified that it has a right to request an administrative hearing pursuant to section 120.569 and 120.57, Florida Statutes, Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency tor Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida, 32308; Christine Thorson Messana, Senior Attorney. 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. Dated thisGt, day of Ataqust, 2097. . 7, Cheer 7 lee Christine T. Messana Pla. Bar. No. 0153818 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive Tallahassee, FL 32308 (850) 922-5873 (office) (850) 413-9313 (fax) ce: Elizabeth Dudek 58/12/2002 19:68 858474995 THE HEALTH CENTER PAGE 19/21 CERTIFICATE OF SERVICE i HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on this (Ln day of Asgast 2002 to: The Health Center of Pensacola, Inc., d/b/a The Health Center of Pensacola, 8475 University Parkway, Pensacola, Plorida 32514. OL 7 Christine T. Messana

Docket for Case No: 02-003508