\ 4} CRITI Division of Administrative Hearings STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATI AGENCY FOR HEALTH CARE ADMINISTRATION, Le, } Petitioner, AHCA No.: 2002040221 Return Receipt Requested: ve 7000 1670 0011 4845 2741 7000 1670 0011 4845 2758 H & C RETIREMENT, INC. d/b/a BEST 7000 1670 0011 4845 2765 RETIREMENT CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against H & C Retirement, Inc. d/b/a Best Retirement Center (hereinafter “Best Retirement Center”), pursuant to Chapter 400, Part III, and Section 120.60, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $5,500.00 pursuant to Sections 400.414, 400.419, Florida Statutes (2001), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57 Fla. Stat., Chapter 28-106, Florida Administrative Code. 3. Venue lies in Broward County, pursuant to Section 120.57 Fla. Stat, Rule 28-106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing adult living facilities, pursuant to Chapter 400, Part III, Florida Statutes (2001), and Chapter 58A-5 Florida Administrative Code. 5. Best Retirement Center operates a 70-bed adult living facility located at 5605 N. W. 27 Court, Lauderhill, Florida 33313. Best Retirement Center is licensed as an Adult Living Facility, under license number 4915. Best Retirement Center was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I BEST RETIREMENT CENTER FAILED TO MAKE EVERY REASONABLE EFFORT TO ENSURE THAT RESIDENTS’ MEDICATIONS WERE REFILLED IN A TIMELY MANNER. RULE 58A-5.0185(7) (f), FLORIDA ADMINISTRATIVE CODE (MEDICATION STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Best Retirement Center was cited with one (1) Class II deficiency pursuant to a complaint investigation [#200203526] conducted on May 23, 2002. 8. Based on the complaint investigation conducted on May 23, 2002 and based on observations, record reviews and interviews, AHCA’s surveyor found that the facility failed to make every reasonable effort to ensure that residents’ medications were refilled in a timely manner, for 6 out of 8 residents whose medications were reviewed. The findings include the following: 9. The surveyor reviewed resident #1's medication observation record (MOR) . The resident's medications included Depakote, Phenobarbital (both medications commonly used for seizures,) Temazepam, Effexor and Seroquel (these three are psychotropic medications), Neurontin and Vioxx, ordered 05/09/02. The MOR was noted to have circled the dates of 05/04 thru 05/08 for all medications. On the back of the resident’s MOR for those dates was written the following "resident out of meds." The administrator reported that the staff did not mean that the meds were not available, however the staff member responsible for providing assistance to the resident reported that the phrase meant that the medications were not in the facility, and therefore not available to the resident. This resident was transferred to the hospital on 05/09/02 for seizures and possible overdose. There was no documentation in the record of any attempts by the facility to refill the medications. 10. The surveyor found that residents #4 and 45 had been transferred to the facility on 04/11/02 from a nursing home. Resident #4 was diagnosed with arrhythmias, hypertension and depression. The following medications were listed on resident #4’s MOR: Paxil, Aciphex, Isosorbide, Norvasc and Risperdal. The MOR had circled entries for all the medications from 05/01 until 05/09 and on the back of the MOR was written "out of meds". Resident #4 was transferred to the hospital on 05/14/02. Resident #5's MOR listed the medications Atarax, Benztropine, Zyprexa, and Celexa (all psychotropic medications). On the back of the resident’s MOR, all the entries for all the meds were circled from 05/01 until 05/20. The staff member present reported that the resident’s medications were not available. The surveyor interviewed the administrator and the administrator reported that the residents had lost their Medicaid coverage transfe the nursing home, and that it has been re-applied for. However, there was no documentation in either resident’s record of any attempts by the facility to obtain the medications. 11. The surveyor reviewed resident #6's MOR. On 05/08 and 05/09 and again on 05/17, the MOR was circled and written on the back was "out of meds" for those dates. The surveyor reviewed the resident’s medications and found that 2 of the 3 ordered medications were present on the day of the investigation, but the medication Klonopin was not present. The staff were interviewed and reported that that medication was not available because the psychiatrist had to re-order it. The administrator reported that the resident currently had no benefits and that there is a 30- day waiting list for the clinic. However, there was no documentation in the resident’s record of the facility's attempts to obtain the refill of the medication. 12. The surveyor reviewed resident #2's medications. All of the resident’s medications were available, however it was noted that there was a blank entry on the MOR. The staff member could not explain why the MOR entry was blank and whether or not the resident had received the medication. The resident was interviewed and reported that for two days one of his/her medicaticns was not available, but that it arrived at the facility last night, 5/22/02, and one medication was dated 05/22, the day before the 5/23/02 survey. 13. The surveyor reviewed resident #3's medications. On the MOR, the surveyor found that from 05/20 to 05/23 the MOR was circled and on the back was written the notation "out of meds" for the resident's multivitamin, vitamin Bl, Folic Acid, and Doxycycline. The surveyor interviewed the administrator and the administrator reported that those meds had just arrived and that the resident was a VA patient and so dependent on the VA to send any meds. The surveyor reviewed the facility’s progress notes and found that there was no documentation of the facility's attempts to obtain the refills. In addition, the surveyor reviewed the resident’s medications and noted that the ordered Zoloft was not available to the resident and not signed off by the staff as given to the resident since 05/20, three days prior to the 5/23 review. The resident was interviewed and reported that the Zoloft had been refused, however, this was not documented in the resident's record. 14. Based on the foregoing, Best Retirement Center violated Rule 58A-5.0185(7) (f£) Florida Administrative Code, SURVEY FEE Pursuant to Section 400.419(9), Florida Statutes, AHCA may assess a survey fee of $500.00 to cover the cost of conducting complaint investigations that result in the finding of a violation that was the subject of the complaint. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Best Retirement Center on Count I. 2. Assess an administrative fine of $5,000.00 against Best Retirement Center on Count I for the Class II violation of Rule 58A-5.0185(7) (£), Florida Administrative Code. 3. Assess a survey fee of $590.00 against Best Retirement Center, pursuant to Section 400.419(9), Florida costs related Lo the investigation and prosecution of this matter, if the Court finds that costs are applicable. 5. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Manchester Building, First Floor, 8355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Kathryn F. Fenske. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Kathryn F. Fenske Assistant General Counsel Agency for Health Care Administration Fla. Bar No.: 0142832 8355 N. W. 53 Street Miami, Florida 33166 (305) 499-2165 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 E. Tiffany West Palm Beach, Florida 33407 (U.S. Mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Adult Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Administrator, Best Retirement Center, 290 Qe T fa 33313; 1 & C REO5 MN. We. 27 Court, Lauderhill, Ratirement Center, Ine., 5605 M, WW. 27 Court, Tauderhill Florida 33313; Hansram Ramrup, 2834 N. W. 55 Avenue, 1-B, Lauderhill, Florida 33313 on this LK day of , 2002. ' Kathryn F. Fenske

Docket for Case No: 02-003952