OA-B P57 ? STATE OF FLORIDA ap a AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. AHCA NOS. 2002019591 2002009691 2001041081 FANNIE LUE FINKLEY d/b/a, LOVING CARE ALF, a/k/a, LOVING CARE RETIREMENT CENTER, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “AHCA”), by and through its undersigned counsel, and files this Administrative Complaint against FANNIE LUE FINKLEY d/b/a LOVING CARE ALF a/k/a LOVING CARE RETIREMENT CENTER (hereinafter “Loving Care ALF”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2001), and alleges: NATURE OF THE ACTION 1. This is an action to revoke Loving Care ALF’s assisted living facility license and to impose a $46,000.00 fine against Loving Care ALF based on: (a) four (4) class II deficiencies and nine (9) uncorrected class III deficiencies found at a survey on or about March 13, 2002; (b) four (4) class II deficiencies found at a survey on or about February 5-6, 2002; and (c) four (4) class Il deficiencies found at a survey on or about July 1-3, 2001, pursuant to Sections 400.414(1)(e), 400.419(1)(b) and (c) and 400.419(3), Florida Statutes (2001). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). 3. AHCA has jurisdiction over Loving Care ALF pursuant to Chapter 400, Part Til, Florida Statutes (2001). 4, Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code (2001). PARTIES 5. AHCA is the regulatory agency responsible for licensure of assisted living facilities and enforcement of all applicable Florida laws and rules governing assisted living facilities pursuant to Chapter 400, Part III, Florida Statutes, and Chapter 58A-5, Florida Administrative Code. 6. Fannie Lue Finkley is an individual residing in the State of Florida at 5705 West Shore Drive, Pensacola, Florida 32526. 7. Fannie Lue Finkley owns and operates Loving Care ALF, a fourteen (14) bed assisted living facility located at 7667 Kipling Street, Pensacola, Florida 32514. Loving Care ALF is licensed by AHCA as an assisted living facility having been issued license number AL9659, certificate number 11306, with an effective date of September 24, 2001 and an expiration date of September 23, 2003. 8. Loving Care ALF is and was at all times material hereto an assisted living facility required to comply with Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code. COUNT I LOVING CARE ALF FAILED TO MAINTAIN IN RESIDENT #6’S RECORD PHYSICIAN’S ORDERS FOR MEDICATION. Rule 58A-5.024(3)(c), Fla. Admin. Code (2001) CLASS II DEFICIENCY 9. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 10. On or about March 13, 2002 AHCA conducted a survey at Loving Care ALF. One class II deficiency was cited against Loving Care ALF based upon the findings below involving resident #6. RESIDENT #6 11. On or about March 13, 2002 an AHCA surveyor reviewed resident #6’s record and interviewed Loving Care ALF’s Administrator. The record did not contain a physician’s order for any of the ten (10) medications listed below: ° Nitroglycerin skin patch apply in the morning and take off each evening. ° Albuterol Inhaler two puffs four times a day. ° Cyproheptadine 4 milligrams twice a day. e Famotidine 20 milligrams twice a day. ° Metoprolol 50 milligrams % tablet twice a day. e Potassium Chloride 10 milli equilivents twice a day. e Enteric Coated Aspirin 325 milligrams in the morning. e Norvasc 5 milligrams in the moming. e Triamterene/Hydrochlorothiazide 75/50 in the morning. e Remeron 15 milligrams at bedtime. 12. During the interview, the Administrator could not produce a physician’s orders for any of the above-named medications listed on the resident’s medication observation record. 13. Based on all of the foregoing, Loving Care ALF violated Rule 58A-5.024(3)(c), Florida Administrative Code, by failing to maintain on the premises resident #6’s record which record included all health care provider’s orders for medications. 14, Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the personal care of resident #6 and directly threatened resident #6’s physical or emotional health, safety, or security. 15. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $5,000.00 fine against Loving Care ALF for a class II deficiency. COUNT If LOVING CARE ALF FAILED TO PROPERLY ADMINISTER MEDICATION TO RESIDENT #3. § 400.4256, Fla. Stat. (2001) Rule 58A-5.0185(3) and/or (4), Fla. Admin. Code (2001) CLASS II DEFICIENCY 16. | AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 17, On or about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class II deficiency was cited against Loving Care ALF based on the findings below involving resident #3. Resident #3 18. On or about March 13, 2002 an AHCA surveyor reviewed resident #3’s record. Resident #3’s medication observation record revealed that resident #3 received ten (10) units of insulin every morning. During an interview with the Administrator, the Administrator admitted to the AHCA surveyor that she draws up the insulin into syringes every week and places them in the refrigerator for resident #3 to self-administrator. 19. Pursuant to Section 400.4256(4)(b), Florida Statutes, the self-administration of medication does not include the preparation of syringes for injection. The Administrator is not a licensed health care professional and therefore should not be preparing syringes for injection. 20. Based on all of the foregoing, Loving Care ALF violated Section 400.4256, Florida Statutes, and Rule 58A-5.0185(3) and/or (4), Florida Administrative Code, by failing to properly administer medication to resident #3. 21. Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the personal care of resident #3 and directly threatened resident #3’s physical or emotional health, safety, or security. 22. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $2,000.00 fine against Loving Care ALF for a class II deficiency. COUNT Il LOVING CARE ALF FAILED TO MAINTAIN AN ACCURATE, DAILY, UP-TO-DATE MEDICATION OBSERVATION RECORD (“MOR”) FOR RESIDENT #6. Rule 58A-5.0185(5)(b), Fla. Admin. Code (2001) CLASS I DEFICIENCY 23. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 24, On or about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class II deficiency was cited against the Loving Care ALF based on the findings below involving resident #6. Resident #6 25. On or about March 13, 2002 an AHCA surveyor reviewed resident #6’s MOR. According to the MOR, resident #6 was receiving eleven (11) different medications (i.e., the ten medications listed in Count I above plus Ativan). Although Ativan was listed on the MOR, there was no documentation on the MOR showing that the medication had been administered to resident #6. 26. On or about March 13, 2002 the surveyor interviewed the Administrator regarding the Ativan. The Administrator informed the surveyor that the Ativan had been discontinued. If the Ativan had been discontinued, there should have been documentation on the MOR showing this change. 27. Based on all of the foregoing, Loving Care ALF violated Rule 58A-5.0185(5)(b), Florida Administrative Code, by failing to maintain an accurate, daily, up-to-date MOR for resident #6. 28. Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the personal care of resident #6 and directly threatened resident #6’s physical or emotional health, safety, or security. 29. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $2,000.00 fine against Loving Care ALF for aclass II deficiency. COUNT IV LOVING CARE ALF FAILED TO OBTAIN RESIDENT #3’S HIGH BLOOD PRESSURE MEDICATION IN A TIMELY MANNER. Rule 58A-5.0185(7)(f), Fla. Admin. Code (2001) CLASS I DEFICIENCY 30. | AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 31. On or about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class II deficiency was cited against Loving Care ALF based on the findings below involving resident #3. Resident #3 32. On or about March 13, 2002 an AHCA surveyor reviewed resident #3’s record. The review revealed that on or about March 7, 2002 resident #3’s physician had ordered Norvasc, 10 milligrams, every day, and Aspirin, 325 milligrams, every day. The active ingredient in Norvasc is Amlodipine, which used to treat high blood pressure. 33. As of the date of the survey on or about March 13, 2002 Loving Care ALF had not obtained resident #3’s prescriptions for either Norvasc or Aspirin. Therefore, resident #3 was not receiving his high blood pressure medication. 34. Based on the foregoing, Loving Care ALF violated Rule 58A-5.0185(7)(f), Florida Administrative Code, by failing to ensure that resident #3’s prescriptions for Norvasc and Aspirin were filled in a timely manner. 35. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class II deficiency because it is related to the personal care of resident #3 and directly threatened resident #3’s physical or emotional health, safety, or security. 36. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $2,000.00 fine against Loving Care ALF for a class II deficiency. COUNT V LOVING CARE ALF FAILED TO INCLUDE DEMOGRAPHIC DATA IN EACH RESIDENT’S RECORD. Rule 58A-5.024(3)(a), Fla. Admin. Code (2001) UNCORRECTED CLASS III DEFICIENCY 37. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 38. Under Rule 58A-5.024(3)(a), Florida Administrative Code, resident records must be maintained on the facility’s premises and include the following demographic data: (1) Name; (2) Sex; (3) Race; (4) Date of birth; (5) Place of birth, if known; (6) Social security number; (7) Medicaid and/or Medicare number, or name of other health insurance carrier; (8) Name, address, and telephone number of next of kin, responsible party, or other person the resident would like to have notified in case of an emergency, and relationship to resident; and (9) Name, address, and phone number of health care provider, and case manager if applicable, SURVEY ON OR ABOUT FEBRUARY 5-6, 2002 39. On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against Loving Care ALF based on the findings below involving resident #1 and resident #2. Resident #1 40. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #1’s record and interviewed Loving Care ALF’s Administrator. The record did not contain all of the required demographic data. The interview with the Administrator revealed no attempt by Loving Care ALF to obtain this information for resident #1. Resident #2 41. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #2’s record and interviewed the Administrator. The record did not contain all of the required demographic data. The interview with the Administrator revealed no attempt by Loving Care ALF to obtain this information for resident #2. 42. _ Based on the foregoing, Loving Care ALF violated Rule 58A-5.024(3)(a), Florida Administrative Code, by failing to include all demographic data in resident #1’s record and/or resident #2’s record, respectively. 43. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to the personal care of resident #1 and/or resident #2 and because it indirectly or potentially threatened resident #1’s and/or resident #2’s physical or emotional health, safety, or security. 44. AHCA gave Loving Care ALF a written mandated correction date of March 7, 2002 in accordance with Section 400.419(1)(c), Florida Statutes. Loving Care ALF, however, failed to correct the class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about March 13, 2002. Based on the foregoing, Loving Care ALF was cited for an uncorrected class III deficiency at the survey on or about March 13, 2002. SURVEY ON OR ABOUT MARCH 13, 2002 45, On or about March 13, 2002, AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against Loving Care ALF based on the findings below involving resident #1 and resident #2 (resident #1 and resident #2 below are not the same residents as resident #1 and resident #2 discussed above for the survey on or about February 5-6, 2002). Resident #1 46. On or about March 13, 2002 an AHCA surveyor reviewed resident #1’s record and interviewed the Administrator. The record did not contain all of the required demographic data. Additionally, during the interview the Administrator was unable to provide the surveyor with any of the missing demographic data. Resident #2 47. On or about March 13, 2002 an AHCA surveyor reviewed resident #2’s record and interviewed the Administrator. Resident #2’s record did not contain all of the required demographic data. Additionally, during the interview the Administrator was unable to provide the surveyor with any of the missing demographic data. 48. Based on the foregoing, Loving Care ALF violated Rule 58A-5.024(3)(a), Florida Administrative Code, by failing to include all demographic data in resident #1’s record and/or resident #2’s record. 49. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class HI deficiency because it is related to the personal care of Loving Care ALF’s residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 50. Pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may impose a $500.00 fine against Loving Care ALF for an uncorrected class II deficiency. COUNT VI LOVING CARE ALF FAILED TO INCLUDE A COPY OF THE MEDICAL EXAMINATION REPORT IN EACH RESIDENT’S RECORD. Section 400.426(4),(5), Fla. Stat. (2001) Rule 58A-5.024(3)(b), Fla. Admin. Code (2001) UNCORRECTED CLASS III DEFICIENCY 51. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. SURVEY ON OR ABOUT FEBRUARY 5-6, 2002 52. On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. A class HI deficiency was cited against the Loving Care ALF based on the findings below involving resident #1, resident #3, resident #5 and resident #6. Resident #1 53. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #1’s record. The record did not contain a copy of the medical examination report as required by law. Loving Care ALF failed to make such report available to AHCA during the survey or upon request. Resident #3 54. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #3’s record. The record did not contain a copy of the medical examination report as required by law. Loving Care ALF failed to make such report available to AHCA during the survey or upon request, 11 Resident #5 55. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #5’s record. The record did not contain a copy of the medical examination report as required by law. Loving Care ALF failed to make such report available to AHCA during the survey or upon request. Resident #6 56. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #6’s record. The record did not contain a copy of the medical examination report as required by law. Loving Care ALF failed to make such report available to AHCA during the survey or upon request. 57. Based on the foregoing, Loving Care ALF violated: (a) Section 400.426(4) and/or (5), Florida Statutes, by failing to ensure that the medical examination report became a part of each resident’s record and by failing to make such report available to AHCA during an inspection or upon request; and (b) Rule 58A-5.024(3)(b), Florida Administrative Code, by failing to maintain a copy of the medical examination report in each resident’s record. 58. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class HI deficiency because it is related to the personal care of resident #1, #3, #5, and/or #6 and because it indirectly or potentially threatened the physical or emotional health, safety, or security or resident #1, #3, #5, and/or #6. 59. | AHCA gave Loving Care ALF a written mandated correction date of March 7, 2002 in accordance with Section 400.419(1)(c), Florida Statutes. Loving Care ALF, however, failed to correct the class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about March 13, 2002. Based on the foregoing, Loving Care ALF was cited for an uncorrected class III deficiency at the survey on or about March 13, 2002. SURVEY ON OR ABOUT MARCH 13, 2002 60. On or about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class Ill deficiency was cited against the Loving Care ALF based on the findings below involving resident #6. Resident #6 61. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #6’s record. The record did not contain a copy of the medical examination report as required by law. Loving Care ALF failed to make such report available to AHCA during the survey or upon request. 62. Based on the foregoing, Loving Care ALF violated: (a) Section 400.426(4) and/or (5), Florida Statutes, by failing to ensure that the medical examination report became a part of resident #6’s record and by failing to make such report available to AHCA during an inspection or upon request; and (b) Rule 58A-5.024(3)(b), Florida Administrative Code, by failing to maintain a copy of the medical examination report in resident #6’s record. 63. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class [I deficiency because it is related to the personal care of resident #6 and because it indirectly or potentially threatened the physical or emotional health, safety, or security of resident #6. 13 64. — Pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may impose a $500.00 fine against Loving Care ALF for an uncorrected class III deficiency. COUNT Vil LOVING CARE ALF FAILED TO ENSURE THAT EACH RESIDENT WAS FREE FROM COMMUNICABLE DISEASE. Rule 58A-5.0181(1)(b), Fla. Admin. Code (2001) UNCORRECTED CLASS III DEFICIENCY 65. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. SURVEY ON OR ABOUT FEBRUARY 5-6, 2002 66. On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against Loving Care ALF based on the findings below involving resident #1, resident #3, resident #5, and resident #6. Resident #1 67. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #1’s record and interviewed the Administrator. The record did not contain any documentation showing that the resident was free from signs and symptoms of any communicable disease, which is likely to be transmitted to other residents or staff. The interview with the Administrator confirmed the foregoing. 14 Resident #3 68. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #3’s record and interviewed the Administrator. The record did not contain any documentation showing that the resident was free from signs and symptoms of any communicable disease, which is likely to be transmitted to other residents or staff. The interview with the Administrator confirmed the foregoing. Resident #5 69. | Onor about February 5-6, 2002 an AHCA surveyor reviewed resident #5’s record and interviewed the Administrator. The record did not contain any documentation showing that the resident was free from signs and symptoms of any communicable disease, which is likely to be transmitted to other residents or staff. The interview with the Administrator confirmed the foregoing. Resident #6 70. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #6’s record and interviewed the Administrator. The record did not contain any documentation showing that the resident was free from signs and symptoms of any communicable disease, which is likely to be transmitted to other residents or staff. The interview with the Administrator confirmed the foregoing. 71. Based on the foregoing, Loving Care ALF violated Rule 58A-5.0181(1)(b), Florida Administrative Code, by failing to ensure resident #1, resident #3, resident #5 and/or resident #6 met the minimum admission criteria of being free from signs and symptoms of any communicable disease which is likely to be transmitted to other residents or staff. 72. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to operation and maintenance of the facility or to the personal care of resident #1, resident #3, resident #5 and/or resident #6 and because it indirectly or potentially threatened the physical or emotional health, safety, or security of resident #1, resident #3, resident #5, and/or resident #6 and other residents in the facility. 73. AHCA gave Loving Care ALF a written mandated correction date of Match 7, 2002, in accordance with Section 400.419(1)(c), Florida Statutes. Loving Care ALF, however, failed to correct the class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about March 13, 2002. Based on the foregoing, Loving Care ALF was cited for an uncorrected class III deficiency at the survey on or about March 13, 2002. SURVEY ON OR ABOUT MARCH 13, 2002 74. Onor about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against the Loving Care ALF based on the findings below involving resident #6. Resident #6 75. On or about March 13, 2002 an AHCA surveyor reviewed resident #6’s record and interviewed the Administrator. The record did not contain any documentation showing that the resident was free from signs and symptoms of any communicable disease, which is likely to be transmitted to other residents or staff. The interview with the Administrator confirmed the foregoing. 16 76. Based on the foregoing, Loving Care ALF violated Rule 58A-5.0181(1)(b), Florida Administrative Code, by failing to ensure that resident #6 met the minimum admission criteria of being free from signs and symptoms of any communicable disease which is likely to be transmitted to other residents or staff. 77. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to the operation and maintenance of the facility or to the personal care of resident #6 and because it indirectly or potentially threatened the physical or emotional health, safety, or security or resident #6 and other residents in the facility. 78. Pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may impose a $500.00 fine against Loving Care ALF for an uncorrected class III deficiency. COUNT VIU LOVING CARE ALF FAILED TO ENSURE THAT EACH RESIDENT WAS EXAMINED BY A PHYSICIAN OR ADVANCED REGISTERED NURSE PRACTITIONER (“ARNP”) WITHIN SIXTY (60) DAYS PRIOR TO ADMISSION BUT NO LATER THAN THIRTY (30) DAYS AFTER ADMISSION. Section 400.426(4),(5), Fla. Stat. (2001) Rule 58A-5.0181(2)(a), Fla. Admin. Code (2001) UNCORRECTED CLASS III DEFICIENCY 79. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. SURVEY ON OR ABOUT FEBRUARY 5-6, 2002 80. On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against Loving Care ALF based on the findings below involving resident #2, resident #3, resident #4, resident #5, and resident #6. Resident #2 81. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #2’s record. Resident #2 was admitted to Loving Care ALF on or about March 1, 2000. The medical examination, however, was not performed until August 14, 2001. Loving Care ALF failed to ensure that resident #2 received an examination by a physician or ARNP within sixty (60) days prior to admission but no later than thirty (30) days after admission to the facility. Resident #3 82. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #3’s record. Resident #3 was admitted to Loving Care ALF on or about September 18, 2001. As of the date of the survey on or about February 5-6, 2002, resident #3 had not received a medical examination by a physician or ARNP. Loving Care ALF failed to ensure that resident #3 received an examination by a physician or ARNP within sixty (60) days prior to admission but no later than 30 days after admission to the facility. Resident #4 83. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #4’s record. Resident #4 was admitted to Loving Care ALF in September of 1999. The medical examination, however, was not performed until on or about April 27, 2000. Loving Care ALF failed to ensure that resident #4 received an examination by a physician or ARNP within sixty (60) days prior to admission but no later than thirty (30) days after admission to the facility. 18 Resident #5 84. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #5’s record. Resident #5 was admitted to Loving Care ALF on or about October 31, 2001. As of the date of the survey on or about February 5-6, 2002, resident #5 had not received a medical examination by a physician or ARNP. Loving Care ALF failed to ensure that resident #5 received an examination by a physician or ARNP within sixty (60) days prior to admission but no later than thirty (30) days after admission to the facility. Resident #6 85. | Onor about February 5-6, 2002 an AHCA surveyor reviewed resident #6’s record and interviewed the Administrator. Resident #6 was admitted to Loving Care ALF on or about September 13, 2000. As of the date of the survey on or about February 5-6, 2002, resident #6 had not received a medical examination by a physician or ARNP. Loving Care ALF failed to ensure that resident #6 received an examination by a physician or ARNP with sixty (60) days prior to admission but no later than thirty (30) days after admission to the facility. During the interview with the Administrator, the Administrator stated that Loving Care ALF was unable to obtain a health examination from a physician for resident #6. 86. Based on the foregoing, Loving Care ALF violated Rule 58A-5.0181(2)(a), Florida Administrative Code, by failing to ensure that each resident received a medical examination by a physician or ARNP within sixty (60) days prior to admission but no later than thirty (30) days after admission to the facility. 87. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class [II deficiency because it is related to the personal care of resident #2, resident #3, resident #4, resident #5 and/or resident #6 and because it indirectly or potentially threatened the physical or emotional health, safety, or security of resident #2, resident #3, resident #4, resident #5 and/or resident #6. 88. | AHCA gave Loving Care ALF a written mandated correction date of March 7, 2002 in accordance with Section 400.419(1)(c), Florida Statutes. Loving Care ALF, however, failed to correct the class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about March 13, 2002. Based on the foregoing, Loving Care ALF was cited for an uncorrected class III deficiency at the survey on or about March 13, 2002. SURVEY ON OR ABOUT MARCH 13, 2002 89. | Onor about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against Loving Care ALF based on the findings below involving resident #6. Resident £6 90. On or about March 13, 2002 an AHCA surveyor reviewed resident #6’s record. Resident #6 was admitted to Loving Care ALF on or about December 1, 1999. As of the date of the survey on or about March 13, 2002 resident #6 had not received a medical examination by a physician or ARNP. Loving Care ALF failed to ensure that resident #6 received an examination by a physician or ARNP within sixty (60) days prior to admission but no later than thirty (30) days after admission to the facility. 20 91. Based on the foregoing, Loving Care ALF violated Rule 58A-5.0181(2)(a), Florida Administrative Code, by failing to ensure that resident #6 received a medical examination by a physician or ARNP within sixty (60) days prior to admission but no later than thirty (30) days after admission to the facility. 92. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to the personal care of resident #6 and because it indirectly or potentially threatened resident #6’s physical or emotional health, safety, or security. 93. Pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may impose a $500.00 fine against Loving Care ALF for an uncorrected class III deficiency. COUNT IX LOVING CARE ALF FAILED TO CONDUCT LEVEL 1 BACKGROUND SCREENING ON ALL EMPLOYEES HIRED ON OR AFTER OCTOBER 1, 1998 WHO PERFORM PERSONAL SERVICES. Section 400.4174(2), Fla. Stat. (2001) Rule 58A-5.019(3), Fla. Admin. Code (2001) UNCORRECTED CLASS III DEFICIENCY 94. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. SURVEY ON OR ABOUT FEBRUARY 5-6, 2002 95. | On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. A class ITI deficiency was cited against Loving Care ALF based on the findings below involving employee #1, employee #2, employee #3, employee #4, employee #5 and employee #6. 21 Employee #1 96. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #1’s personnel file and interviewed the Administrator. Employee #1 was hired on or after October 1, 1998 and provides personal services to residents. The personnel file did not contain any evidence of a level 1 background screening for employee #1. During the interview with the Administrator, the Administrator admitted to the AHCA surveyor that a level 1 background screening had not been conducted for employee #1 as the Administrator was unaware of this legal requirement. Employee #2 97. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #2’s personnel file and interviewed the Administrator. Employee #2 was hired on or about January 20, 2002 and provides personal services to residents. The personnel did not contain any evidence of a level 1 background screening for employee #2. During the interview, the Administrator admitted to the AHCA surveyor that a level 1 background screening had not been conducted for employee #2 as the Administrator was unaware of this legal requirement. Employee #3 98. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #3’s personnel file and interviewed the Administrator. Employee #3 was hired on or after October 1, 1998 and provides personal services to residents. The personnel file did not contain any evidence of a level 1 background screening for employee #3. During the interview with the Administrator, the Administrator admitted to the AHCA surveyor that a level 1 background screening had not been conducted for employee #3 as the Administrator was unaware of this legal requirement. 22 Employee #4 99. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #4’s personnel file and interviewed the Administrator. Employee #4 was hired on or after October 1, 1998 and terminated his/her employment with Loving Care ALF on or about January 18, 2002. Employee #4 provided personal services to residents while employed at Loving Care ALF. The record did not contain any evidence of a level 1 background screening for employee #4. During the interview, the Administrator admitted to the AHCA surveyor that a level 1 background screening had not been conducted for employee #4 as the Administrator was unaware of this legal requirement. Employee #5 100. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #5’s personnel file and interviewed the Administrator. Employee #5 was hired on or after October 1, 1998 and provides personal services to residents. The personnel file did not contain any evidence of a level 1 background screening for employee #5. During the interview with the Administrator, the Administrator admitted to the AHCA surveyor that a level 1 background screening had not been conducted for employee #5 as the Administrator was unaware of this legal requirement. Employee #6 101. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #6’s personnel file and interviewed the Administrator. Employee #6 was hired on or after October 1, 1998 and provides personal services to residents. The personnel file did not contain any evidence of a level 1 background screening for employee #6. During the interview with the Administrator, the Administrator admitted to the AHCA surveyor that a level 1 background 23 screening had not been conducted for employee #6 as the Administrator was unaware of this legal requirement. 102. Based on the foregoing, Loving Care ALF violated Section 400.4174(2), Florida Statutes, and Rule 58A-5.019(3), Florida Administrative Code, by failing to conduct level 1 background screening on all employees hired on or after October 1, 1998 to provide personal services to residents. 103. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class Ill deficiency because it is related to the operation and maintenance of a facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 104. AHCA gave Loving Care ALF a written mandated correction date of February 15, 2002 in accordance with Section 400.419(1)(b) and (c), Florida Statutes. Loving Care ALF, however, failed to correct the deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about March 13, 2002. Although this deficiency was classified as a class II deficiency at the survey on or about February 5-6, 2002 AHCA lowered the classification to a class II deficiency at the survey on or about March 13, 2002. Based on the foregoing, Loving Care ALF was cited for an uncorrected class II deficiency at the survey on or about March 13, 2002. SURVEY ON OR ABOUT MARCH 13, 2002 105. On or about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against the Loving Care ALF based on the findings below involving employee #3 and employee #4. 24 Employee #3 106. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #3’s personnel file and interviewed the Administrator. Employee #3 was hired on or after October 1, 1998 and provides personal services to residents. The record did not contain any evidence of a level 1 background screening for employee #3. During the interview with the Administrator, the Administrator was unable to produce any documentation evidencing that the background screening had been performed. Loving Care ALF failed to conduct a level 1 background screening on employee #3. Employee #4 107. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #4’s personnel file and interviewed the Administrator. Employee #4 was hired on or about January 20, 2002 and provides personal services to residents. The record did not contain any evidence of a level 1 background screening for employee #4. During the interview, the Administrator was unable to produce any documentation evidencing that the background screening had been performed. Loving Care ALF failed to conduct a level 1 background screening on employee #4. 108. Based on the foregoing, Loving Care ALF violated Section 400.4174(2), Florida Statutes, and Rule 58A-5.019(3), Florida Administrative Code, by failing to conduct level 1 background screening on all employees hired on or after October 1, 1998 to provide personal services to residents. 109. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to the operation and maintenance of a facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 25 110. Pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may impose a $500.00 fine against Loving Care ALF for an uncorrected class III deficiency. COUNT X LOVING CARE ALF FAILED TO ENSURE THAT EACH STAFF MEMBER’S PERSONNEL RECORD CONTAINED VERIFICATION OF FREEDOM FROM COMMUNICABLE DISEASE INCLUDING TUBERCULOSIS. Section 400.4275(2), (4), Fla. Stat. (2001) Rule 58A-5.024(2)(a), Fla. Admin. Code (2001) UNCORRECTED CLASS III DEFICIENCY 111. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. SURVEY ON OR ABOUT FEBRUARY 5-6, 2002 112. On or about February 5-6, 2002, AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against Loving Care ALF based on the findings below involving employee #1, employee #2, employee #3, employee #5 and employee #6. Employee #1 113. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #1’s personnel record. Employee #1 is a staff member of Loving Care ALF. The record did not contain verification of freedom from communicable disease including tuberculosis. Employee #2 114. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #2’s personnel record. Employee #2 is a staff member of Loving Care ALF. The record did not contain verification of freedom from communicable disease including tuberculosis. 26 Employee #3 115. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #3’s personnel record. Employee #3 is a staff member of Loving Care ALF. The record did not contain verification of freedom from communicable disease including tuberculosis. Employee #5 116. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #5’s personnel record. Employee #5 is a staff member of Loving Care ALF. The record did not contain verification of freedom from communicable disease including tuberculosis. Employee #6 117. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #6’s personnel record. Employee #6 is a staff member of Loving Care ALF. The record did not contain verification of freedom from communicable disease including tuberculosis. 118. Based on the foregoing, Loving Care ALF violated Section 400.4275(2) and (4), Florida Statutes, and Rule 58A-5.024(2)(a), Florida Administrative Code, by failing to ensure that each staff member’s personnel record contained verification of freedom from communicable disease including tuberculosis. 119. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class LI deficiency because it is related to the operation and maintenance of a facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 27 120. AHCA gave Loving Care ALF a written mandated correction date of March 7, 2002 in accordance with Section 400.419(1)(c), Florida Statutes. Loving Care ALF, however, failed to correct the class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about March 13, 2002. Based on the foregoing, Loving Care ALF was cited for an uncorrected class III deficiency at the survey on or about March 13, 2002. SURVEY ON OR ABOUT MARCH 13, 2002 121. On or about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against the Loving Care ALF based on the findings below involving employee #3 and employee #4. Employee #3 122. On or about March 13, 2002 an AHCA surveyor reviewed employee #3’s personnel record. Employee #3 is a staff member of Loving Care ALF. The record did not contain verification of freedom from communicable disease including tuberculosis. Employee #4 123. On or about March 13, 2002 an AHCA surveyor reviewed employee #4’s personnel record. Employee #4 is a staff member of Loving Care ALF. The record did not contain verification of freedom from communicable disease including tuberculosis. 124. Based on the foregoing, Loving Care ALF violated Section 400.4275(2) and (4), Florida Statutes, and Rule 58A-5.024(2)(a), Florida Administrative Code, by failing to ensure that each staff member’s personnel record contained verification of freedom from communicable disease including tuberculosis. 28 125. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class HI deficiency because it is related to the operation and maintenance of a facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 126. Pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may impose a $500.00 fine against Loving Care ALF for an uncorrected class III deficiency. COUNT XI LOVING CARE ALF FAILED TO ENSURE THAT ALL FACILITY EMPLOYEES COMPLETED BIENNIALLY A CONTINUING EDUCATION COURSE ON HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNE DEFICIENCY SYNDROME (HIV/AIDS) AND FAILED TO ENSURE THAT SUCH TRAINING WAS DOCUMENTED IN EACH EMPLOYEE’S PERSONNEL RECORD. Section 400.4275(2) and (4), Fla. Stat. (2001) Rule 58A-5.0191(3) and (10), Fla. Admin. Code (2001) Rule 58A-5.024(2)(a)1, Fla. Admin. Code (2001) UNCORRECTED CLASS ITI DEFICIENCY 127. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. SURVEY ON OR ABOUT FEBRUARY 5-6, 2002 128. On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against Loving Care ALF based on the findings below involving employee #1, employee #3, employee #4, employee #5, employee #6 and employee #7. ploy! ploy ploy: ploy: ploy: ploy! 29 Employee #1 129. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #1’s personnel record. The record did not contain documentation of compliance with HIV/AIDS training. Employee #3 130. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #3’s personnel record. The record did not contain documentation of compliance with HIV/AIDS training. Employee #4 131. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #4’s personnel record. The record did not contain documentation of compliance with HIV/AIDS training. Employee #5 132. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #5’s personnel record. The record did not contain documentation of compliance with HIV/AIDS training. Employee #6 133. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #6’s personnel record. The record did not contain documentation of compliance with HIV/AIDS training. 30 Employee #7 134. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #7’s personnel record. The record did not contain documentation of compliance with HIV/AIDS training. 135. Based on the foregoing, Loving Care ALF violated Section 400.4275(2) and (4), Florida Statutes, and Rule 58A-5.0191(3) and (10) and Rule 58A-5.024(2)(a)1, Florida Administrative Code, by failing to ensure that all facility employees completed biennially a continuing education course on HIV/AIDS and that each employee’s personnel record contained documentation evidencing completion of such training. 136. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to the operation or maintenance of the facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 137. AHCA gave Loving Care ALF a written mandated correction date of March 7, 2002 in accordance with Section 400.419(1)(c), Florida Statutes. Loving Care ALF, however, failed to correct the class III deficiency by the mandated correction date and the same deficiency was discovered at the survey conducted on or about March 13, 2002. Based on the foregoing, Loving Care ALF was cited for an uncorrected class III deficiency at the survey on or about March 13, 2002. 31 SURVEY ON OR ABOUT MARCH 13, 2002 138. On or about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against the Loving Care ALF based on the findings below involving employee #3 and employee #4. Employee #3 139. On or about March 13, 2002 an AHCA surveyor reviewed employee #3’s personnel record. The record did not contain documentation of compliance with HIV/AIDS training. Employee #4 140. On or about March 13, 2002 an AHCA surveyor reviewed employee #4’s personnel record. The record did not contain documentation of compliance with HIV/AIDS training. 141. Based on the foregoing, Loving Care ALF violated Section 400.4275(2) and (4), Florida Statutes, and Rule 58A-5.0191(3) and (10) and Rule 58A-5.024(2)(a)1, Florida Administrative Code, by failing to ensure that all facility employees completed biennially a continuing education course on HIV/AIDS and that each employee’s personnel record contained documentation evidencing completion of such training. 142. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to the operation or maintenance of the facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 143. Pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may impose a $500.00 fine against Loving Care ALF for an uncorrected class III deficiency. 32 COUNT XII LOVING CARE ALF FAILED TO ENSURE THAT ALL UNLICENSED PERSONS WHO ASSIST RESIDENTS WITH THE SELF-ADMINISTRATION OF MEDICATION RECEIVED A MINIMUM OF FOUR (4) HOURS OF TRAINING PRIOR TO ASSUMING THIS RESPONSIBILITY. Section 400.4256, Fla. Stat. (2001) Section 400.452(5), Fla. Stat. (2001) Rule 58A-5.0191(5), Fla. Admin. Code (2001) Rule 58A-5.024(2)(a)1, Fla. Admin. Code (2001) UNCORRECTED CLASS III DEFICIENCY 144, AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. SURVEY ON OR ABOUT FEBRUARY 5-6, 2002 145. Onor about February 5-6, 2002, AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against Loving Care ALF based on the findings below involving employee #1, employee #2, employee #4, employee #5, and employee #6. Employee #1 146. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #1’s personnel record. Employee #1 is not licensed to practice nursing or medicine. Employee #1 is employed by or under contract with Loving Care ALF. Employee #1 provides assistance to residents with the self-administration of medication. The record did not contain documentation showing that employee #1 received a minimum of four (4) hours of training prior to assuming this responsibility. Employee #1 failed to complete the required training prior to assisting residents with the self-administration of medication. 33 Employee #2 147. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #2’s personnel record. Employee #2 is not licensed to practice nursing or medicine. Employee #2 is employed by or under contract with Loving Care ALF. Employee #2 provides assistance to residents with the self-administration of medication. The record did not contain documentation showing that employee #2 received a minimum of four (4) hours of training prior to assuming this responsibility. Employee #2 failed to complete the required training prior to assisting residents with the self-administration of medication. Employee #4 148. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #4’s personnel record. Employee #4 is not licensed to practice nursing or medicine. Employee #4 is employed by or under contract with Loving Care ALF. Employee #4 provides assistance to residents with the self-administration of medication. The record did not contain documentation showing that employee #4 received a minimum of four (4) hours of training prior to assuming this responsibility. Employee #4 failed to complete the required training prior to assisting residents with the self-administration of medication. Employee #5 149. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #5’s personnel record. Employee #5 is not licensed to practice nursing or medicine. Employee #5 is employed by or under contract with Loving Care ALF. Employee #5 provides assistance to residents with the self-administration of medication. The record did not contain documentation showing that employee #5 received a minimum of four (4) hours of training prior to assuming 34 this responsibility. Employee #5 failed to complete the required training prior to assisting residents with the self-administration of medication. Employee #6 150. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #6’s personnel record. Employee #6 is not licensed to practice nursing or medicine. Employee #6 is employed by or under contract with Loving Care ALF. Employee #6 provides assistance to residents with the self-administration of medication. The record did not contain documentation showing that employee #6 received a minimum of four (4) hours of training prior to assuming this responsibility. Employee #6 failed to complete the required training prior to assisting residents with the self-administration of medication. 151. Based on the foregoing, Loving Care ALF violated Sections 400.4256 and 400.452(5), Florida Statutes, and Rules S8A-5.0191(5) and 58A-5.024(2)(a)1, Florida Administrative Code, by failing to ensure that each staff member who assists residents with the self-administration of medication completes a minimum of four (4) hours of training prior to assuming this responsibility and by failing to ensure that each staff member’s personnel record contained documentation evidencing completion of such training. 152. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to the operation or maintenance of the facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 153. AHCA gave Loving Care ALF a written mandated correction date of February 15, 2002 in accordance with Section 400.419(1)(b) and (c), Florida Statutes. Loving Care ALF, however, failed to correct the deficiency by the mandated correction date and the same 35 deficiency was discovered at the survey conducted on or about March 13, 2002. Although this deficiency was classified as a class II deficiency at the survey on or about February 5-6, 2002 AHCA lowered the classification to a class III deficiency at the survey on or about March 13, 2002. Based on the foregoing, Loving Care ALF was cited for an uncorrected class III deficiency at the survey on or about March 13, 2002. SURVEY ON OR ABOUT MARCH 13, 2002 154. On or about March 13, 2002, AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against the Loving Care ALF based on the findings below involving employee #3 and employee #4. Employee #3 155. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #3’s personnel record. Employee #3 is not licensed to practice nursing or medicine. Employee #3 is employed by or under contract with Loving Care ALF. Employee #5 provides assistance to residents with the self-administration of medication. The record did not contain documentation showing that employee #3 was trained to assist residents with the self-administration of medication. Employee #3 failed to complete the required training prior to assisting residents with the self-administration of medication. Employee #4 156. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #4’s personnel record. Employee #4 is not licensed to practice nursing or medicine. Employee #4 is employed by or under contract with Loving Care ALF. Employee #4 provides assistance to residents with the self-administration of medication. The record did not contain documentation showing that employee #4 was trained to assist residents with the self-administration of 36 medication. Employee #1 failed to complete the required training prior to assisting residents with the self-administration of medication. 157. Based on the foregoing, Loving Care ALF violated Sections 400.4256 and 400.452(5), Florida Statutes, and Rules 58A-5.0191(5) and 58A-5.024(2)(a)1, Florida Administrative Code, by failing to ensure that each staff member who assists residents with the self-administration of medication completes a minimum of four (4) hours of training prior to assuming this responsibility and that each staff member’s personnel record contained documentation evidencing completion of such training. 158. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to the operation or maintenance of the facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 159. Pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may impose a $500.00 fine against Loving Care ALF for an uncorrected class III deficiency. COUNT XIII LOVING CARE ALF FAILED TO ENSURE THAT THE PERSONNEL RECORD FOR EACH STAFF PERSON HIRED ON OR AFTER OCTOBER 1, 1998 TO PROVIDE PERSONAL SERVICES TO RESIDENTS CONTAINED DOCUMENTATION OF COMPLIANCE WITH THE LEVEL 1 BACKGROUND SCREENING REQUIREMENT. Section 400.4275(2) and (4), Fla. Stat. (2001) Rule 58A-5.024(2)(a)3, Fla. Admin. Code (2001) Rule 58A-5.019(3)(b), Fla. Admin. Code (2001) UNCORRECTED CLASS II DEFICIENCY 160. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 37 SURVEY ON OR ABOUT FEBRUARY 5-6, 2002 161. On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against Loving Care ALF based on the findings below involving employee #1, employee #2, employee #3, employee #4, employee #5 and employee #6. ’ Employee #1 162. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #1’s personnel file and interviewed the Administrator. Employee #1 was hired on or after October 1, 1998 and provides personal services to residents. The record did not contain any evidence of a level 1 background screening for employee #1. Employee #2 163. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #2’s personnel file and interviewed the Administrator. Employee #2 was hired on or about January 20, 2002 and provides personal services to residents. The record did not contain any evidence of a level 1 background screening for employee #2. Employee #3 164. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #3’s personnel file and interviewed the Administrator. Employee #3 was hired on or after October 1, 1998 and provides personal services to residents. The record did not contain any evidence of a level 1 background screening for employee #3. Employee #4 165. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #4’s personnel file and interviewed the Administrator. Employee #4 was hired on or after October 1, 1998 and terminated his/her employment with Loving Care ALF on or about January 18, 2002. 38 Employee #4 provided personal services to residents whiled employed at Loving Care ALF. The record did not contain any evidence of a level 1 background screening for employee #4. Employee #5 166. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #5’s personnel file and interviewed the Administrator. Employee #5 was hired on or after October 1, 1998 and provides personal services to residents. Employee #5’s personnel record did not contain any evidence of a level 1 background screening for employee #5. Employee #6 167. On or about February 5-6, 2002 an AHCA surveyor reviewed employee #6’s personnel file and interviewed the Administrator. Employee #6 was hired on or after October 1, 1998 and provides personal services to residents. The record did not contain any evidence of a level 1 background screening for employee #6. 168. Based on the foregoing, Loving Care ALF violated Section 400.4275(2) and (4), Florida Statutes, and Rules 58A-5.024(2)(a)3 and 58A-5.019(3)(b), Florida Administrative Code, by failing to maintain documentation of compliance with level 1 background screening including the results of such screening in each employee’s personnel file. 169. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class III deficiency because it is related to the operation and maintenance of a facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 170. AHCA gave the Loving Care ALF a written mandated correction date of February 15, 2002 in accordance with Section 400.419(1)(b) and (c), Florida Statutes. Loving Care ALF, however, failed to correct the deficiency by the mandated correction date and the same 39 deficiency was discovered at the survey conducted on or about March 13, 2002. Although this deficiency was classified as a class II deficiency at the survey on or about February 5-6, 2002 AHCA lowered the classification to a class III deficiency at the survey on or about March 13, 2002. Based on the foregoing, Loving Care ALF was cited for an uncorrected class III deficiency at the survey on or about March 13, 2002. SURVEY ON OR ABOUT MARCH 13, 2002 171. Onor about March 13, 2002 AHCA conducted a survey at Loving Care ALF. A class III deficiency was cited against the Loving Care ALF based on the findings below involving employee #3 and employee #4. Employee #3 172. On or about March 13, 2002 an AHCA surveyor reviewed employee #3’s personnel file and interviewed the Administrator. Employee #3 was hired on or after October 1, 1998 and provides personal services to residents. The record did not contain any evidence of a level 1 background screening for employee #3. During the interview with the Administrator, the Administrator was unable to produce any documentation evidencing that the background screening had been performed. Employee #4 173. On or about March 13, 2002 an AHCA surveyor reviewed employee #4’s personnel file and interviewed the Administrator. Employee #4 was hired on or after October 1, 1998 and provides personal services to residents. The record did not contain any evidence of a level 1 background screening for employee #4. During the interview, the Administrator was unable to produce any documentation evidencing that the background screening had been performed. 40 174. Based on the foregoing, Loving Care ALF violated Section 400.4275(2) and (4), Florida Statutes, and Rules 58A-5.024(2)(a)3 and 58A-5.019(3)(b), Florida Administrative Code, by failing to maintain documentation of compliance with level 1 background screening including the results of such screening in each employee’s personnel file. 175. Pursuant to Section 400.419(1)(c), Florida Statutes, the foregoing is a class II deficiency because it is related to the operation and maintenance of a facility or to the personal care of residents and because it indirectly or potentially threatened the physical or emotional health, safety, or security of residents in the facility. 176. Pursuant to Section 400.419(1)(c), Florida Statutes, AHCA may impose a $1,000.00 fine against Loving Care ALF for an uncorrected class III deficiency. COUNT XIV LOVING CARE ALF FAILED TO MAINTAIN PHYSICIAN’S ORDERS FOR MEDICATION IN RESIDENT RECORDS. Rule 58A-5.024(3)(c), Fla. Admin. Code (2001) CLASS I DEFICIENCY 177. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 178. On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. One class II deficiency was cited against Loving Care ALF based upon the findings below involving resident #1, resident #2, resident #3, resident #4, resident #5 and resident #6. 41 Resident #1 179. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #1’s record and interviewed the owner of Loving Care ALF (the “Owner”). The record did not contain a physician’s order for any of the medication listed below, which medication was being administered to resident #1. e Depakote 500 milligrams ° Klonopin 2 milligrams e Baclofen 10 milligrams e Benzotropine 180. During the interview with the Owner, the Owner could not produce a physician’s orders for any of the above medication. Resident #2 181. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #2’s record and interviewed the Owner. The record did not contain a physician’s order for any of the medication listed below, which medication was being administered to resident #2. e Prozac 10 milligrams e Hyzarr 100 milligrams e Maxzide 25 milligrams e Pericolace 182. During the interview with the Owner, the Owner could not produce a physician’s orders for any of the above medication. 42 Resident #3 183. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #3’s record and interviewed the Owner. The record did not contain a physician’s order for any of the medication listed below, which medication was being administered to resident #3. e Gentamycin ointment e Combivent Inhaler e Tobramycin eye drops ° Risperdal 3 milligrams e Depakote 500 milligrams e Lortab e Synthyroid e Prevacid 30 milligrams e Seroquel 25 milligrams ° Erythromycin e Klonopin 5 milligrams e Neurotin ° Clonidine e Theophylline 184, During the interview with the Owner, the Owner could not produce a physician’s orders for any of the above medication. 43 Resident #4 185. Onor about February 5-6, 2002 an AHCA surveyor reviewed resident #3’s record and interviewed the Owner. The record did not contain a physician’s order for any of the medication listed below, which medication was being administered to resident #4. ° Buspar 15 milligrams e Remeron 45 milligrams e Protonix 40 milligrams e Plavix 75 milligrams e Thiamine 100 milligrams 186. During the interview with the Owner, the Owner could not produce a physician’s orders for any of the above medication. Resident #5 187. Onor about February 5-6, 2002 an AHCA surveyor reviewed resident #5’s record and interviewed the Owner. The record did not contain a physician’s order for any of the medication listed below, which medication was being administered to resident #5. e Klonopin ft milligram e Tegretol 200 milligrams e Depakote 500 milligrams 188. During the interview with the Owner, the Owner could not produce a physician’s orders for any of the above medication. 44 Resident #6 189. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #6’s record and interviewed the Owner. The record did not contain a physician’s order for any of the medication listed below, which medication was being administered to resident #6. e Glyburide 5 milligrams e Fosmopril N.A. 20 milligrams e Terazosin HCL 2 milligrams e Levothyroxide .5 milligrams e Insulin 10 units e Aspirin 325 milligrams e Stertraline 100 milligrams 190. During the interview with the Owner, the Owner could not produce a physician’s orders for any of the above medication. 191. Based on all of the foregoing, Loving Care ALF violated Rule 58A-5.024(3)(c), Florida Administrative Code, by failing to include in resident #1’s, resident #2’s, resident #3’s, resident #4’s, resident #5’s and/or resident #6’s record, respectively, all health care provider’s orders for medication. 192. Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the personal care of resident #1, resident #2, resident #3, resident #4, resident #5, and/or resident #6 and directly threatened resident #1’s resident #2’s, resident #3’s, resident #4’s, resident #5’s and/or resident #6’s physical or emotional health, safety, or security. 45 193. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $5,000.00 fine against Loving Care ALF for a class II deficiency. COUNT XV LOVING CARE ALF FAILED TO PROPERLY ADMINISTER MEDICATION TO RESIDENT #6. § 400.4256, Fla. Stat. (2001) Rule 58A-5.0185(3),(4), Fla. Admin. Code (2001) CLASS IT DEFICIENCY 194. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 195. On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. A class II deficiency was cited against Loving Care ALF based on the findings below involving resident #6. Resident #6 196. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #6’s record. Resident #6’s medication observation record revealed that resident #6 received NPH Insulin 10 units every morning. During an interview with Loving Care ALF’s Administrator/Owner, the Administrator/Owner admitted to the AHCA surveyor that she draws up the insulin into syringes every week and places them in the refrigerator for the resident to self-administrator. 197. Pursuant to Section 400.4256(4)(b), Florida Statutes, the self-administration of medication does not include the preparation of syringes for injection. The Administrator is not a licensed health care professional and should not be preparing syringes for injection. 46 198. Based on all of the foregoing, Loving Care ALF violated Section 400.4256, Florida Statutes, and Rule 58A-5.0185(3) and/or (4), Florida Administrative Code, by failing to properly administer medication to resident #6. 199, Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the personal care of resident #6 and directly threatened resident #6’s physical or emotional health, safety, or security. 200. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $5,000.00 fine against Loving Care ALF for a class II deficiency. COUNT XVI LOVING CARE ALF FAILED TO MAINTAIN AN ACCURATE, DAILY, UP-TO-DATE MEDICATION OBSERVATION RECORD (“MOR”) FOR RESIDENT #1, RESIDENT #2, RESIDENT #4 AND/OR RESIDENT #5. Rule 58A-5.0185(5)(b), Fla. Admin. Code (2001) CLASS II DEFICIENCY 201. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 202. On or about February 5-6, 2002 AHCA conducted a survey at Loving Care ALF. A class II deficiency was cited against the Loving Care ALF based on the findings below involving resident #1, resident #2, resident #4, and resident #5. Resident #1 203. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #1’s record and medication. The record review revealed that resident #1 was admitted to Loving Care ALF on or about February 1, 2002. The review further revealed that resident #1 did not have a MOR for the four (4) medications he was receiving. The surveyor reviewed resident #1’s medication and found the following four (4) prescriptions: (1) Depakote, 500 milligrams, 1 tablet in the 47 morning and 1 tablet in the evening; (2) Klonopin, 2 milligrams, 1 tablet three times a day; (3) Baclofen, 10 milligrams, 1 tablet twice a day; and (4) Benzotropine, 1 tablet twice a day. 204. On or about February 5-6, 2002 an AHCA surveyor interviewed the Administrator. The Administrator stated that resident #1 was receiving all four (4) medications since his admission. 205. Based on the foregoing, Loving Care ALF failed to maintain an accurate, daily, up-to-date MOR for resident #1. Resident #2 206. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #2’s record. The MOR listed the following three (3) medications: (1) Prozac, 90 milligrams, 1 weekly; (2) Hyzar, 100/25, 1 daily; and (3) Pericolace, 1 tablet twice daily. Resident #2 was scheduled to receive his Prozac on February 3, 2002. The MOR showed resident #2 as receiving the Hyzar and Pericolace. The MOR, however, did not show resident #2 as receiving his Prozac on February 3, 2002. 207. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #2’s medications and found the following prescriptions: (1) Prozac, 90 milligrams, 1 tablet weekly; (2) Hyzar, 100/25 1 tablet daily; and (3) Maxzide, 25 milligrams, 1 tablet daily. 208. On or about February 5-6, 2002 an AHCA surveyor interviewed the Administrator. The stated that resident #2 was receiving Prozac, Hyzar and Maxzide (not Percolace as shown on the MOR). No Percolace was found in resident #2’s medication. 209. Based on the foregoing, Loving Care ALF failed to maintain an accurate, daily, up-to-date MOR for resident #2. 48 Resident #4 210. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #4’s record. The following medications were listed on the MOR: (1) Folic Acid 1 milligram every day; (2) Plavix 75 milligrams every day; (3) Prinivil 10 milligrams every day; (4) Protonix 10 milligrams every day; (5) Thiamine 100 milligrams every day; (6) Buspar 5 milligrams three tablets three times a day; and (7) Remeron 45 milligrams one every night at bedtime. According to the MOR, all of the foregoing medications were administered to resident #4 on or about February 5-6, 2002. However, six of the seven medications were not found in resident #4’s medication box as stated in the paragraph below. 211. On or about February 5-6, 2002 an AHCA surveyor observed the following medications in resident #4’s medication box: (1) Thiamine 50 milligrams two tablets twice a day; (2) Aciphex 20 milligrams thirty minutes before every meal; (3) Clonidine 0.1 milligrams every twelve hours; (4) Lisinopril 10 milligrams every day; and (5) prenatal vitamin every day. Folic Acid, Plavix, Prinivil, Protonix EC, Buspar, and Remeron were listed on the MOR but were not in the medication box. 212. Based on the foregoing, Loving Care ALF failed to maintain an accurate, daily, up-to-date MOR for resident #4. Resident #5 213. On or about February 5-6, 2002 an AHCA surveyor reviewed resident #5’s record. The following five medications were listed on the MOR: (1) Depakote 500 milligrams three tablets every morning and two tablets at bedtime; (2) Tegretol 200 milligrams two tablets twice a day; (3) Neurontin 100 milligrams three times a day; (4) Albuteral two puffs four times a day; and (5) Klonopin 1 milligram two tablets at bedtime. According to the MOR, all of the 49 foregoing medications were administered to resident #5 on or about February 5-6, 2002. However, two of the five medications were not found in resident #5’s medication box as stated in the paragraph below. 214. On or about February 5-6, 2002 an AHCA surveyor observed the following medications in resident #5°s medication box: (1) Klonopin 1 milligram two tablets at bedtime; (2) Tegretol 200 milligrams two tablets twice a day; and (3) Depakote 500 milligrams three tablets in the morning and two tablets at bedtime. The Nerontin and Albuterol Inhaler were listed on the MOR but were not in the resident’s medication box. 215. On or about February 5-6, 2002 an AHCA surveyor interviewed the Administrator. The Administrator stated that resident #5’s mother may have the Albuterol Inhaler. The Administrator further stated to the AHCA surveyor that the MOR was inaccurate because resident #5 did not receive his Albuterol Inhaler on the day of the survey, although the MOR shows this medication as being administered to the resident. 216. Based on the foregoing, Loving Care ALF failed to maintain an accurate, daily, up-to-date MOR for resident #5. 217. Based on all the foregoing, Loving Care ALF violated Rule 58A-5.0185(5)(b), Florida Administrative Code, by failing to maintain an accurate, daily, up-to-date MOR for resident #1, resident #2, resident #4 and/or resident #5. 218. Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the personal care of resident #1, resident #2, resident #4, and/or resident #5 and directly threatened the physical or emotional health, safety, or security of resident #1, resident #2, resident #4 and/or resident #5. 50 219. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $5,000.00 fine against Loving Care ALF for a class II deficiency. COUNT XVII LOVING CARE ALF FAILED TO EMPLOY THE CONSULTANT SERVICES OF A LICENSED PHARMACIST OR LICENSED REGISTERED NURSE AND/OR FAILED TO PROVIDE AHCA WITH PROOF OF THE FOREGOING. Section 400.442, Fla. Stat. (2001) Rule 58A-5.033(4), Fla. Admin. Code (2001) CLASS II DEFICIENCY 220. On or about July 1-3, 2001 an AHCA surveyor performed a survey on Loving Care ALF. At this survey, AHCA documented at least one class II deficiency against Loving Care ALF regarding medicinal drugs or over-the-counter preparations, including their storage, use, delivery, or administration. 221. Pursuant to Section 400.442, Florida Statutes, and Rule 58A-5.033(4), Florida Administrative Code, AHCA notified Loving Care ALF that it was required to hire a licensed pharmacist consultant or registered nurse no later than July 9, 2001 to address the medication related problems discovered at the survey on or about July 1-3, 2001. 222. During the survey on or about February 5-6, 2002 an AHCA surveyor reviewed Loving Care ALF’s records. The records contained no evidence of the employment of a consultant including, but not limited to, a copy of the consultant’s professional license. 223. During the survey on or about February 5-6, 2002 an AHCA surveyor interviewed the Administrator. The Administrator was unable to provide any evidence of the employment by the facility of a consultant. 224, Pursuant to Section 400.442, Florida Statutes, and Rule 58A-45.033(4), Florida Administrative Code, Loving Care ALF must employ a consultant until the 51 facility receives written notification from AHCA that consultant services are no longer necessary. AHCA never notified Loving Care ALF that such services were no longer necessary. Loving Care ALF failed to a employ consultant and/or failed to continue to employ a consultant until AHCA determined that such consultant services were no longer necessary. 225. Based on the foregoing, Loving Care ALF violated Section 400.442, Florida Statutes, and Rule 58A-5.033(4), Florida Administrative Code, by: (a) failing to employ a consultant; (b) failing to continue to employ a consultant; and/or (c) failing to have available for review by AHCA evidence of such employment including, but not limited to, a copy of the consultant’s license. 226. Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the operation and maintenance of the facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security of residents in the facility. 227. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $5,000.00 fine against Loving Care ALF for a class II deficiency. COUNT XVIII LOVING CARE ALF FAILED TO MAINTAIN PHYSICIAN’S ORDERS FOR MEDICATION IN RESIDENT #1’S RECORD AND RESIDENT #3'S RECORD, RESPECTIVELY. Rule 58A-5.024(3)(c), Fla. Admin. Code (2001) CLASS IT DEFICIENCY 228. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 52 229. On or about July 1-3, 2001 AHCA conducted a survey at Loving Care ALF. One class II deficiency was cited against Loving Care ALF based upon the findings below involving resident #1 and resident #3. Resident #1 230. On or about July 1-3, 2001 an AHCA surveyor reviewed resident #1’s medical record. The record did not contain a physician’s order for any of the following medications, which medications were listed on the medication observation record and were present in the medication container: ° Micro-K 10 milligrams ° Extentabs one daily ° Zyrtec 10 milligrams one daily e Haldol 2 milligrams one at hour of sleep Resident #3 231. On or about July 1-3, 2001 an AHCA surveyor reviewed resident #3’s medical record. The record did not contain a physician’s order for “Plavix 75 milligrams one daily”, which medication was listed on the medication observation record as being administered to resident #3. 232. Based on all of the foregoing, Loving Care ALF violated Rule 58A-5.024(3)(c), Florida Administrative Code, by failing to maintain in resident #1’s medical record and resident #3’s medical record, respectively, all health care provider’s orders for medication. 53 233. Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the personal care of resident #1 and/or resident #3 and directly threatened resident #1’s and/or resident #3’s physical or emotional health, safety, or security. 234. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $2,500 fine against Loving Care ALF for a class II deficiency. COUNT IXx LOVING CARE ALF FAILED TO MAINTAIN A MINIMUM STAFF HOURS OF 212 PER WEEK FOR A CENSUS OF 6-15 RESIDENTS. Rule 58A-5.019(4)(a)1, Fla. Admin. Code (2001) CLASS IH DEFICIENCY 235. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 236. On or about July 1-3, 2001 AHCA conducted a survey at Loving Care ALF. One class II deficiency was cited against Loving Care ALF based upon the findings below. 237. On or about July 1-3, 2001 an AHCA surveyor interviewed Loving Care ALF’s Administrator. The Administrator was unable to produce a written 24-hour staffing schedule for the month of July 2001. During the interview, the Administrator stated that the facility maintained a minimum of 168 staff hours per week with an average daily census of greater than six (6) residents. 238. On the day of the survey, July 1-3, 2001 the census at Loving Care ALF was fourteen (14) residents. 54 239. Pursuant to Rule 58A-5.019(4)(a)1, Florida Administrative Code, Loving Care ALF must maintain a minimum of 212 staff hours per week, not 168 staff hours, for fourteen (14) residents. 240. Based on all of the foregoing, Loving Care ALF violated Rule 58A-5.019(4)(a)1, Florida Administrative Code, by failing to maintain 212 minimum staff hours per week as required for a census of fourteen (14) residents. 241. Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the operation and maintenance of the facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security or the Loving Care ALF’s residents. 242. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $2,500.00 fine against Loving Care ALF for a class II deficiency. COUNT XX LOVING CARE ALF FAILED TO MAINTAIN AN ACCURATE, DAILY, UP-TO-DATE MEDICATION OBSERVATION RECORD (“MOR”) FOR RESIDENT #1 AND RESIDENT #3, RESPECTIVELY. Rule 58A-5.0185(5)(b), Fla. Admin. Code (2001) CLASS II DEFICIENCY 243. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 244. On or about July 1-3, 2001 AHCA conducted a survey at Loving Care ALF. A class II deficiency was cited against Loving Care ALF based on the findings below involving resident #1 and resident #3, respectively. 55 Resident #1 245. On or about July 1-3, 2001 an AHCA surveyor reviewed resident #1’s medical record and discovered that Loving Care ALF failed to maintain an accurate, daily, up-to-date MOR for resident #1. 246. At approximately 1:00 p.m. on or about July 1, 2001 an AHCA surveyor reviewed resident #1’s MOR. “Haldol 2 milligrams one at hour of sleep (8:00 p.m.)” was signed off by staff as given to resident #1 at 8:00 p.m. that same day, although it was only 1:00 p.m. at the time of the record review. Additionally, the resident’s chart contained a physician’s order for “Propoxyphene 650 milligrams twice daily as needed for pain”. Propoxyphene, however, was not listed on resident #1’s MOR. Therefore, resident #1 was not receiving the Propoxyphene. Resident #3 247. On or about July 1-3, 2001 an AHCA surveyor reviewed resident #3’s medical record and discovered that Loving Care ALF failed to maintain an accurate, daily, up-to-date MOR for resident #3. 248. At approximately 1:00 p.m. on or about July 1, 2001 an AHCA surveyor reviewed resident #3’s MOR. The MOR listed “Buspar 15 mg. one three times daily (8:00 A.M., 12:00 Noon, 8:00 P.M.).” All three (3) medication administration times were signed off by staff as given to resident #3 including the 8:00 p.m. administration time even though it was only 1:00 p.m. at the time of the record review. The MOR also listed “Remeron 45 mg. one at hour of sleep (8:00 p.m.).” Remeron was also signed off by staff as administered to the resident at 8:00 p.m. that day even though it was only 1:00 p.m. at the time of the record review. 56 249. Further, the resident’s chart contained a physician’s order for “Multivitamin one daily”. The multivitamin, however, was not listed on resident #3’s MOR. Therefore, it is likely that resident #3 was not receiving the multivitamin. 250. Finally, the MOR listed “Plavix 75 mg. one daily (8:00 A.M.)”, but the physician’s order contained in resident #3’s medical record was for “one at hour of sleep”. The MOR was inaccurate as Resident #3 was receiving Plavix in the morning rather than in the evening as per the physician’s order. 251. Based on all the foregoing, Loving Care ALF violated Rule 58A-5.0185(5)(b), Florida Administrative Code, by failing to maintain an accurate, daily, up-to-date MOR for resident #1 and resident #3, respectively. 252. Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the personal care of resident #1 and/or resident #3 and directly threatened the physical or emotional health, safety, or security of resident #1 and/or resident #3. 253. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $2,500.00 fine against Loving Care ALF for a class II deficiency. COUNT XXI LOVING CARE ALF FAILED TO ENSURE THAT ALL PRESCRIPTION DRUGS KEPT BY THE FACILITY WERE PROPERLY LABELED AND DISPENSED. Rule 58A-5.0185(7)(a), Fla. Admin. Code (2001) CLASS I DEFICIENCY 254. AHCA re-alleges and incorporates by reference paragraphs one (1) through eight (8) above as if fully set forth herein. 57 255. On or about July 1-3, 2001 AHCA conducted a survey at Loving Care ALF. A class II deficiency was cited against the Loving Care ALF based on the findings below involving resident #3. Resident #3 256. On or about July 1-3, 2001 an AHCA surveyor observed medication bottles and reviewed resident #3’s medical record and discovered that labels on medication bottles differed from the physician’s order and/or the medication observation record. 257. On or about July 1-3, 2001 the AHCA surveyor observed the medication Remeron in resident #3’s medication box. “Remeron 15 mg” was written on the box containing the medication but there was no label on the box with instructions for medication administration. The medication observation record and the physician’s order listed “Remeron 45 mg. one at hours of sleep”. Based on the foregoing, there was no way to determine if Resident #3 was receiving 45 milligrams, not 15 milligrams, of Remeron as prescribed by the physician. 258. The surveyor also discovered differences between what was written on the medication label and the medication observation record. Lisinopril 10 milligrams was written on the label and Prinivil 10 milligrams, one daily, was written on the medication observation record. Prinivil is the brand name for the active ingredient, Lisinopril, used to treat high blood pressure and heart failure. The medication label was not properly labeled to ensure accurate administration of the medication. 58 259. Vitamin B-1 50 milligrams was written on the medication bottle and Thiamine HCL 100 milligrams, one daily, was written on the medication observation record and on the physician’s order contained in the medical record. Vitamin B-1 is the brand name for the active ingredient Thiamine. The medication label was not properly labeled to ensure accurate administration of the medication. 260. Based on all the foregoing, Loving Care ALF violated Rule 58A-5.0185(7)(a), Florida Administrative Code, by failing to ensure that prescription drugs kept by the facility were properly labeled and dispensed in accordance with Chapters 465 and 499, Florida Statutes. 261. Pursuant to Section 400.419(1)(b), Florida Statutes, the foregoing violation is a class II violation because it is related to the personal care of resident resident #3 and directly threatened resident #3’s physical or emotional health, safety, or security. 262. Pursuant to Section 400.419(1)(b), Florida Statutes, AHCA may impose a $2,500.00 fine against Loving Care ALF for a class II deficiency. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: 1) Make factual and legal findings in favor of AHCA on Counts I though XX]; 2) Impose a $46,000.00 fine against Loving Care ALF pursuant to Sections 400.414(1)(e) and 400.419(1)(b) and (c), Florida Statutes (2001); 3) Revoke Loving Care ALF’s assisted living facility license pursuant to Section 400.414(1)(e), Florida Statutes (2001); and 4) Grant any other legal and equitable relief as deemed necessary in the furtherance of justice. 59 NOTICE Loving Care ALF hereby 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 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 Lori C. Desnick, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida, 32308. THE LOVING CARE ALF IS FURTHER NOTIFIED THAT THE 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 ACHA. Respectfully submitted on this day of July 2002. + CO. Degree ky Lori C. Desnick Fla. Bar. No. 0129542 Counsel for Petitioner Agency for Health Care Administration Building 3, Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0071 (office) (850) 921-0158 (fax) 60 CERTIFICATE OF SERVICE J] HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint has been sent by U.S. Certified Mail Return Receipt Requested (return receipt # TMOG 45 VS 124 4- 2060 3324 to Fannie Lou Finkley, Administrator, Fannie Lou Finkley d/b/a Loving Care ALF a/k/a Loving Care Retirement Center, 7667 Kipling Street, Pensacola, Florida 32514 on this bladay of July, 2002. hi _C : LORI C. DESNICK, ESQUIRE 61 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION EXPLANATION OF RIGHTS UNDER SEC, 120.569, FLORIDA STATUTES (To be used in conjunction with Election of Rights form — attached) In response to the allegations set forth in the Administrative Complaint issued by the Agency for Health Care Administration ("AHCA” or “Agency”), you must make one of the following elections within twenty-one (21) days from the date of receipt of the Administrative Complaint. Please make your election of the attached Election of Rights form and return it fully executed to the address listed on the form. OPTION 1. tf you do nat dispute the allegations in the Administrative Complaint and waive your right to be heard, you should select OPTION 1 on the election of rights form. A final order will be entered finding you guilty of the violations charged and imposing the penalty sought in the Complaint. You will be provided a copy of the final order. OPTION 2. If you do not dispute any material fact alleged in the Administrative Complaint (you admit each of them), you may request an informal hearing pursuant to Section 120.57(2), Florida Statutes (2001) before the Agency. At the informal hearing, you will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal hearing, you should select OPTION 2 on the Election of Rights form. OPTION 3. If you dispute the allegations set forth in the Administrative Complaint (you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes (2001). To obtain a formal hearing, select OPTION 3 on the Election of Rights form. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. In order to preserve your right to a hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Administrative Complaint. If you do not respond at all within twenty-one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint. STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RE: AHCA v. Fannie Lue Finkley d/b/a Loving Care ALF, alk/a Loving Care Retirement Center CASE NOS. 2002019591, 2002009691, and 2001041081 ELECTION OF RIGHTS PLEASE SELECT ONLY 1 OF THE 3 OPTIONS An Explanation of Rights is attached. OPTION ONE (1) 6 ! do not dispute the allegations of fact contained in the Administrative Complaint and waive my right to object or to be heard. | understand that by waiving my rights, a final order will be issued that adopts the Administrative Complaint and imposes the sanctions sought. OPTION TWO (2) 0 I do not dispute and | admit the allegations of fact in the Administrative Complaint, but do wish to be afforded an informal proceeding, pursuant to Section 120.57(2), Florida Statutes, at which time | will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) 0 / do dispute the allegations of fact contained in the Administrative Complaint and request a formal hearing, pursuant to Section 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings. If you choose OPTION THREE (3), in order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. In order to preserve your right to any hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Administrative Complaint. tf you do not respond at all within twenty-one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint. If you have elected either OPTION TWO (2) or THREE (3) above and you are interested in discussing a settlement of this matter with the Agency, please also mark this block. 6 Mediation under Section 120.573, Florida Statutes, is not available in this matter. SEND NO PAYMENT NOW -- REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL YOU RECEIVE A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES. (Please sign and fill in your current address.) Respondent (Licensee) Address: License. No. and facility type: Phone No. PLEASE RETURN YOUR COMPLETED FORM TO: Lori C. Desnick, Senior Attorney, Agency for Health Care Administration, (Note: Overnight Deliveries to 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308 -5403.) Telephone Number: 850/922-5873; FAX 850/413- 9313; TOD 1-800-955-8771.

Docket for Case No: 02-003851