STATE OF FLORIDA 92 opr. AGENCY FOR HEALTH CARE ADMINISTRATION “9 py STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, INP Petitioner, AHCA NO.: 2002045340 vs. AHCA NO.: 2002045781 PARADISE PINES HEALTH CARE ASSOCIATES d/b/a HARTS HARBOR HEALTH CARE 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 PARADISE PINES HEALTH CARE ASSOCIATES d/b/a HARTS HARBOR HEALTH CARE CENTER, (“Harts Harbor Health Care Center”), pursuant to Section 120.569, and 120.57, Fla. Stat. (2001), alleges: NATURE OF THE ACTION lL. This is an action to impose an administrative fine against Harts Harbor Health Care Center, pursuant to Section 400.23(8)c), Fla. Stat. (2001), 42 C.F.R. 483.25(a)-(m); 42 C.F.R. 483.25(m)(1), 42 C.F.R. 483.60(a), 42 C.F.R. 483.75(j), and Rules 59A-4.1288, and 59A-4.112(1), Florida Administrative Code (2002). The Agency also intends to impose a conditional rating effective June 28, 2002 through November 30 2002, pursuant to Section 400.23(7)(b), Fla. Stat. (2002) case no 2002045781. JURISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2002). 3. Venue lies in Duval County, Jacksonville, Florida, pursuant to Section 120.57, Florida Statutes (2001), and Chapter 59A-4, Florida Administrative Code (2002). 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing skilled nursing facilities pursuant to Chapter 400, Part II, Fla. Stat. (2002), and Chapter 59A-4 Florida Administrative Code. 5. Harts Harbor Health Care Center is a for-profit corporation, whose 180-bed nursing home is located at 11565 Harts Road, Jacksonville, Florida. Harts Harbor Health Care Center is licensed as a skilled nursing facility license #SNF15640961; certificate number 8865, effective June 28, 2002 through November 30, 2002. Harts Harbor Health Cate Center was at all time material hereto, a licensed faciliry under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNT I HARTS HARBOR HEALTH CARE CENTER FAILED TO PROVIDE THE NECESSARY CARE AND SERVICES FOR ONE (1) OF 15 SAMPLED RESIDENTS (RESIDENT #15) BY FOLLOWING PHYSICIAN ORDERS FOR RESIDENTS WITH JDENTIFIED NEED FOR THICKENED LIQUIDS. IT WAS NOTED THAT RESIDENT #15 WAS CITED DURING THE ANNUAL SURVEY OF MAY 21-24, 2002, FOR BEING AT RISK FOR ASPIRATION AND WAS PROVIDED WITH THIN LIQUIDS FEDERAL TAG F309-QUALITY OF CARE 42 C.E.R. 483.25 QUALITY OF CARE Section 59A-4.1288, Fla. Admin. Code. (2002) EXCEPTION 6. AHCA tealleges and incorporates paragraphs (1) through (5)-as if fully set forth herein. 7. On or about May 24, 2002, AHCA conducted an annual survey at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a.) Harts Harbor Health Care Center failed to provide the necessary Care and services for two (2) of 26 residents (Resident #14 and #15) and one randomly sampled resident (R27) the facility did not provide the necessary care and services by following physician orders for all residents with identified need for thickened liquids and at risk for aspiration to attain or maintain the highest practicable physician and psychosocial well being in accordance with the comprehensive assessment and plan of care. b.) During the follow-up survey on June 28, 2002, Harts Harbor Health Care Center failed to provide the necessary care and services for 1 of 15 sampled residents (Resident #15) by following physician orders for residents with identified need for thickened liquids. It was noted that Resident #15 was cited during the annual survey of May 21-24, 2002 for being at risk for aspiration and was provided with thin liquids. 8. The above constitutes a violation of Section 42 C. F. R. 483.25, requiring that each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. 9. The Respondent was provided a mandated correction date of June 24, 2002. The violation alleged herein constitutes an uncorrected Class III deficiency, and warrants a fine of $1,000.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $1,000.00. COUNT IH HARTS HARBOR HEALTH CARE CENTER FAILED TO ENSURE A MEDICATION ERROR RATE OF LESS THAN 5% (5 ERRORS NOTED DURING OBSERVATION OF MEDICATION PASSES WITH 56 OPPORTUNITIES FOR ERROR), RESULTING IN A MEDICATION ERROR RATE OF 8.9%, PRESENTING THE POTENTIAL FOR RESIDENT TO RECEIVE LESS THAN THE PRESCRIBED MEDICATION NEEDED TO ENSURE OPTIMAL HEALTH AND WELL-BEING FEDERAL TAG F332-QUALITY OF CARE Section 59A-4.1288 Fla. Admin. Code (2002) EXCEPTION 10. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 11. Onor about May 24, 2002, AHCA conducted an annual survey at the Respondent facility. AHCA cited the Respondent based on the findings below, to wit: a) Harts Harbor Health Care Center failed to ensure a medication error rate of less than 5% (8 errors noted during observation of two medication passes with 47 opportunities for error), resulting in a medication error rate of 17%, presenting the potential for resident to receive less than the prescribed amount of medication needed to ensure optimal health and well-being. b) During the follow-up survey on June 28, 2002, Harts Harbor Health Care Center failed to ensure a medication error rate of less than 5 % (5 errors were noted during observation of medication passes with 56 opportunities for error), resulting in a medication error rate of 8.9%, presenting the potential for residents to receive less than the prescribed medication needed to ensure optimal health and well-being. 2, The above constitutes a violation of Section 42 C.F.R. 483.25(m)(1), requiring that medications errors—The facility must ensure that- It is free of medication error rates of five percent or greater; or 2. Residents are free of any significant medication errors. 13. The Respondent was provided a mandated correction date of June 24, 2002. The violation alleged herein constitutes an uncorrected Class III deficiency, and warrants a fine of $2,000.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the allegations of this administrative complaint. 2, Impose a fine in the amount of $2,000.00. COUNT HI HARTS HARBOR HEALTH CARE CENTER DID NOT ENSURE DURING THE FACILITY’S IN-HOUSE PREPARATION OF BOTH THE “ PHYSICIAN’S ORDERS” AND THE “MEDICATION ADMINISTRATION RECORD”, THAT THERE WAS CORRECT OR SPECIFIC TRANSCRIPTION OF MEDICATION PASS ON THE NORTH HILL (N 1A, N 7B, N 144). THERE WAS NO EVIDENCE THAT THE FACILITY COULD ENSURE THAT THESE RESIDENTS RECEIVED THE PRECISE MEDICAL INTERVENTIONS INTENDED FEDERAL TAG F426- PHARMACY SERVICES Section 59A-4.112(1), Fla. Admin. Code (2002) PHARMACY SERVICES 14. AHCA tealleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 15. On or about May 24, 2002, AHCA conducted an annual survey at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a.) Harts Harbor Health Care Center did not to ensure during the facility’s in- house preparation of both the “physician’s orders’ and the “medication administration record”, there were incorrect or frequency of administration, form of drug, and routes of administration for 6 out of 26 sampled residents (# 5, 17, 18, 19, 21, and 26). b.) During the follow-up survey on June 58, 2002, Harts Harbor Health Care Center did not ensure the facility’s in-house preparation of the “Physician’s Order” and the Medication Administration Record (MAR) that there was correct or specific transcription of medication frequency of administration, form of drug, and routes of administration for 3 out of 12 sampled resident (Resident #8, 10, 26) and for 3 out of 8 residents observed during medication pass on the North Hall (N 1A, N 7B, N 14A). There was these residents received the precise medical interventions intended. 16. The above constitutes a violation of Section 42 C.ER. 483,60(a), requiring that a facility must pharmaceceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administrating of all drugs and biologicals) to meet the needs of each resident. 17. The Respondent was provided a mandated correction date of June 24, 2002. The violation alleged herein constitutes an uncorrected Class IIL deficiency, and warrants a fine of $2,000.00. 18. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $2,000.00. COUNT IV HARTS HARBOR HEALTH CARE CENTER DID NOT ENSURE THAT LABORATORY SERVICES WERE PROVIDED, PROVIDED IN A TIMELY MANNER AND THAT THERE WAS FOLLOW-UP WHEN NEEDED FOR 3 OF 15 SAMPLED RESIDENTS. IT WAS NOTED THAT FOR SAMPLED RESIDENTS #8, 21 AND 29, THE FACILITY DID NOT PROVIDED LABORATORY TESTING AS ORDER BY THE PHYSICIAN FEDERAL TAG F502- ADMINISTRATION Section 594-4.1288 Fla. Admin. Code (2002) EXCEPTION 19. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 20. On or about May 24, 2002, AHCA conducted an annual survey at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a.) Harts Harbor Health Care Center failed to provide or obtain laboratory services ordered by the physician in a timely manner to meet the needs of the resident. c.) During the follow-up survey on June 28, 2002, Harts Harbor Health Care Center did not ensure that laboratory services were provided, provided in a timely manner and that there was follow-up when needed for 3 of 15 sampled residents. It was noted that for sampled Residents #8, 21 and 29, the facility did not provided laboratory testing as ordered by the physician. 21. The above constitutes a violation of Section 42 CFR. 483.75(j), requiring that the must provide or obtain laboratory services to meet the needs of its residents. The facility is responsible for the quality and timeliness of the services. 22. The Respondent was provided a mandated correction dated of June 24, 2002. The violation alleged herein constitutes an uncorrected Class III deficiency. And warrants a fine of $1,000.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual legal findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $1,000.00. The above also constitutes a violation of Section 400.23(8)(c), Fla. Stat. (2001), providing that a class II deficiencies are those which the agency determines will result in no more than minimal physical, mental, ot psychosocial discomfort to the resident or has the potential to compromise the resident’s ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class III deficiency is subject to a civil penalty of $1,000 for an isolated deficiency, $2, 000 for a patterned deficiency, and $3,000 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A citation for a class III deficiency must specify the time within which the deficiency is required to be corrected. If a class II deficiency is corrected within the time specified, no civil penalty shall be imposed. The above constitutes a violation of Section 59A-4.1288, Florida Administrative Code (2002) requiring that nursing homes that participate in Tile XVIII or XIX must follow certification rules and regulations found in 42 CER. 483, requirements for Long Term Care Facilities, September 26, 1991, which is incorporated by reference. Non-certified facilities must follow the contents of this rule and the standards contained in the Conditions of Participation found in 42 C.E.R. 483, requirements for Long Term Care Facilities, September 26, 1991, which is incorporated by reference with respect to social services, dental services, infection control, dietary and the therapies. Respondent is notified that they have a right to request an administrative hearing pursuant to 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael Mathis, Senior Attorney. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Florida. Michael O. Mathis Fla. Bar. No. 0325570 Counsel for Petitioner, Agency for HealthCare Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0055 (office) (850) 413-9313 (fax) Karen Swann Lealand McCharen Agency for Health Care Administration CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on Sf. gi day of Seppheomban, 2002 to: Connie M. Bend, Administrator, Harts Harbor Health Care Center, 11565 Harts Road, Jacksonville, Florida 32218. Michael O. 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Docket for Case No: 02-004169