Division of Administrative Hearings STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRA AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA CASE NO: 20820+66t4¢-+—4 Petitioner, Certified Article Number 710b 4575 1294 2050 3133 a\2+ Vv. SENDERS RECORD ALTERRA HEALTHCARE CORPORATION, d/b/a ALTERRA WYNWOOD OF PALMER RANCH EAST, 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 ALTERRA HEALTHCARE CORPORATION, d/b/a ALTERRA WYNWOOD OF PALMER © RANCH EAST, hereinafter “Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2001), and alleges the following: . Nature of the Action eceld th a . : ee . wis 1. This is an action to impose an administrative fine and any applicable survey fee upon of pO Respondent pursuant to Chapter 400, Part IH, Florida Statutes (2002). Jurisdiction And Venue 2. AHCA, and the Division of Administrative Hearings in the event a formal hearing is iM requested, have jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. AHCA has jurisdiction over Respondent pursuant to Chapter 400, Part III, Florida athe ah Statutes. me 4. Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code. Parties 5 .Pursuant to Chapter 400, Part III, Florida Statutes, and Rules 58A-5, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules. 6. Respondent is an assisted living facility located at 5111 Palmer Ranch Parkway, Sarasota, Florida 34238. Respondent is and was at all times material hereto a licensed facility under Chapter 400, Part III, Florida Statutes and Chapter 58A-5, Florida Administrative Code, having been issued license number 9737. COUNTI Alleged Violation of Medication Standard _ Related to Disposition of Expired Medications [Fla, Admin. Code R. 58A-5.0185(6)(e); §400.419 Fla.Stat. (2001)] 7, AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 8. The regulatory provisions of the Florida Administrative Code that are pertinent to this alleged violation, read as follows: 58A-5.0185 Medication Practices. Pursuant to Sections 400.4255 and 400.4256, F.S., and this rule, facilities holding a standard, limited mental health, extended congregate care, or limited nursing services license may assist with the self- administration or administration of medications to residents in a facility. * ” * (6) MEDICATION STORAGE AND DISPOSAL. * ok Ok (¢) Medications which have been abandoned or which have expired must be disposed of within 30 days of being determined abandoned or expired and disposition shall be documented in the resident’s record. The medication may be taken to a pharmacist for disposal or may be destroyed by the administrator or designee with one witness. 9. On or about November 20, 2001, AHCA completed a survey at Respondent’s facility and cited Respondent for a deficiency regarding the above referenced medication standards related to disposition of expired medications within 30 days of the expiration date of the medication. More specifically, the findings of the survey include: During the tour of the facility on 11/19/01 at 9:35 A.M., the surveyor observed three expired medications in the medication cabinet of Resident #1. The medications were prescription medications of: "Hydro Jodo cream (expired on 5/3/01), Elocon 1% cream (expired on 6/98) and Hydrocortisone cream (expired on 5/10/01). The Health Assessment for this resident on 9/25/01, revealed that he needed assistance with his medication and verification by the nurse revealed the facility administered his medications. Interview with the resident revealed, "The staff give me my medications." 10. Respondent’s aforesaid failure to dispose of medication prior to its expiration date, as set forth in the November 2001 citation, constitutes a class III violation (one which the agency determines “indirectly or potentially” threatens the physical or emotional health, safety or security of the facility residents) of the requirements of Fla. Admin. Code R. 58A-5.0185(6)(e). 11. On or about August 5, 2002, AHCA completed a survey at Respondent’s facility and cited Respondent for a deficiency regarding the above referenced medication standards related to disposition of expired medications within 30 days of the expiration date of the medication. More specifically, based on a review of 2 residents’ medications and Medication Observation Records (MOR), the facility did not ensure that expired medication (Cepacol) of one of the residents (Resident #4) was disposed of within 30 days of the expiration date. A review of Resident #4's medication box revealed the presence of Cepacol that should have been reordered by June of 2002 and was not. The expired Cepacol remained in the medication box for use for the resident. 12. Respondent’s aforesaid failure to dispose of medication prior to its expiration date, as set forth in the survey of August 5, 2002, also constitutes a class III violation of the requirements of Fla. Admin. Code R. 58A-5.0185(6)(e). 13. The second violation alleged herein constitutes a repeat Class III violation of the referenced regulatory rules governing Respondent’s operation of its facility. As a repeat class III violation, AHCA is authorized by law pursuant to §400.419 Fla.Stat. (2001), to assess an administrative fine against Respondent in an amount of not less than $500 and not exceeding $1,000 for each violation. The facts and circumstances here warrant imposition of a fine of $500. 14. AHCA is not seeking assessment of a survey fee as to this violation. COUNT I Alleged Violation of Medication Practices Standard Related to Medication Labeling and Orders [Fla. Admin. Code R. 58A-5.0185(7)(d); §400.419 Fla Stat. (2001). ] 15. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 16. The regulatory provisions of the Florida Administrative Code that are pertinent to this alleged violation, read as follows: 58A-5.0185 Medication Practices. Pursuant to Sections 400.4255 and 400.4256, F.S., and this rule, facilities holding a standard, limited mental health, extended congregate care, or limited nursing services license may assist with the self- administration or administration of medications to residents in a facility. * ” * (7) MEDICATION LABELING AND ORDERS. * x” (d) Any change in directions for use of a medication for which the facility is providing assistance with self-administration or administering medication must be accompanied by a written medication order issued and signed by the resident’s health care provider, or a faxed copy of such order. The new directions shall promptly be recorded in the resident’s medication observation record. The facility may then place an “alert” label on the medication container which directs staff to examine the revised directions for use in the MOR, or obtain a revised label from the pharmacist. 17. On or about November 20, 2001, AHCA completed a survey at Respondent’s facility and cited Respondent for a deficiency regarding the above referenced medication practices rule related to labeling and orders. More specifically, as to this citation, Medication Observation Records (MORs) for certain residents of the facility called for medications to be given to these certain residents (2 of 9 sampled) every night “at bedtime.” However, the facility’s nurses gave the medications at 5:00 P.M. every day, without any written medication order issued and signed by the resident’s health care provider, or a faxed copy of such order. The findings of the survey include that, as to one of these residents in the Alzheimer’s Unit, Respondent’s Resident Health Coordinator stated that the orders were for HS (hour of sleep) but that “bedtime was early in the Alzheimer’s Unit.” The surveyor determined that dinner in the facility was not until 5:15 P.M. 18. Respondent’s failure to secure a written medical order issued and signed by the resident’s health care provider, or a faxed copy of such order, authorizing the administration of the medications at the times administered by Respondent’s staff, constitutes a class III violation (one which the agency determines “indirectly or potentially” threatens the physical or emotional health, safety or security of the facility residents) of the requirements of Fla. Admin. Code R 58A-5.0185(7)(d). 19. On or about August 5, 2002, AHCA completed a survey at Respondent’s facility and again cited Respondent for a deficiency regarding the above referenced medication practices rule related to medication labeling and orders. More specifically, as to this citation, Medication Observation Records (MORs) for a certain resident of the facility called for that resident’s medication (lotrisone cream) to be applied “four times a day.” However, for this resident two tubes were located with conflicting directions on each as to the application of this resident’s referenced medication, only one of which was labeled for the medication to be administered “qid’ as ordered. The other tube was labeled for the medication to be applied TID (three times a day). There was no label alert noted on this second tube. 20. As to this second referenced citation for a deficiency under the above referenced medication practices rule related to medication labeling and orders, Respondent either (a) failed to secure any written medication order issued and signed by the resident’s health care provider, or a faxed copy of such order, authorizing the administration of the medication at the times indicated on the tubes for administration of the medication by Respondent’s staff; or alternatively, (b) failed to consistently label both tubes with any new directions differing from those on the resident’s MOR, failed to promptly record any such new directions in the resident’s medication observation record, and failed to place any “alert” label on the medication tubes which directed staff to examine any such revised directions for use in the MOR, or obtain a revised label from the pharmacist. 21. As to the second referenced citation, Respondent’s failure to secure a written medical order issued and signed by the resident’s health care provider, or a faxed copy of such order, authorizing the application of the medication at the times indicated on the labels on the two tubes for administration of the medication by Respondent’s staff, constitutes a class III violation of the requirements of Fla. Admin. Code R. 58A-5.01 85(7)(d). 22. The second violation alleged herein constitutes a repeat Class III violation of the referenced regulatory rules governing Respondent’s operation of its facility. As a repeat class III violation, AHCA is authorized by law pursuant to §400.419 Fla Stat. (2001), to assess an administrative fine against Respondent in an amount of not less than $500 and not exceeding $1,000 for each violation. The facts and circumstances here warrant imposition of a fine of $500. 23. AHCA is not seeking assessment of a survey fee as to this violation. COUNT II Alleged Violation of Staffing Standards and Records Rules Related to Examination of Newly Hired Staff for Freedom from Communicable Disease [Fla. Admin. Code R. 58A-5.019(2)(a) & S8A-5.024(2)(a); 400.419 Fla Stat. (2001) 24. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 25. The regulatory provisions of the Florida Administrative Code that are pertinent to this alleged violation, read as follows: 58A-5.019 Staffing Standards. * Ok OF (2) STAFF. (a) Newly hired staff shall have 30 days to submit a statement from a health care provider, based ona examination conducted within the last six months, that the person does not have any signs or symptoms of a communicable disease including tuberculosis. * Ok Ok 58A-5.024 Records. The facility shall maintain the following written records in a form, place and system ordinarily employed in good business practice and accessible to department and agency staff. * ” cd (2) STAFF RECORDS, (a) Personnel records for each staff member shall contain, ata minimum, a copy of the original employment application with references furnished and verification of freedom from communicable disease including tuberculosis. 26. On or about May 8, 2002, AHCA completed a survey at Respondent’s facility and cited Respondent for a deficiency regarding the above referenced staffing and records mules related to examination of newly hired staff for communicable disease. More specifically, as to this citation, as to a certain employee hired by Respondent on January 19, 2002, the surveyor’s examination of the facility’s records for the employee showed no record or documentation that the employee was free of communicable disease, including tuberculosis. _The surveyor afforded Respondent’s Residence Director an opportunity to locate the required record and documentation for said employee, but she stated she was unable to locate any such record or documentation. 27. Respondent’s failure to possess and furnish such record or documentation to the surveyor on the day of the aforesaid survey constitutes a Class III violation (one which the agency determines “indirectly or potentially” threatens the physical or emotional health, safety or security of the facility residents) of the regulatory requirements of the Florida Administrative Code as specifically set forth above in this count. 28. On or about August 5, 2002, AHCA completed a survey at Respondent’s facility and cited Respondent for a deficiency regarding the above referenced staffing and records rules related to examination of newly hired staff for communicable disease. More specifically, as to this second citation, Respondent failed to secure the required records of freedom from communicable disease from three employees hired by Respondent respectively on December 15, 2001 (employee #3), February 5, 2002 (employee #4) and May 15, 2002 (employee #5). The surveyor’s examination of the facility’s personnel files for the three employees showed the following: a) that there was a physical examination dated May 10, 2002, as to employee #3; and b) that as to the other two employees, there was no record of any statement that either employee was free of communicable disease, including tuberculosis. Respondent’s administrative staff confirmed to the surveyor on the survey date that Respondent’s files on these employees did not contain the required statements and documentation. 29. Respondent's failure to possess and furnish such statements or documentation to the surveyor on the date of the second aforesaid survey, constitutes a class III violation of the regulatory requirements of the Florida Administrative Code as specifically set forth above in this count. 30. The second violation alleged herein constitutes a repeat Class III violation of the regulatory requirements of the Florida Administrative Code as specifically set forth above in this count. As a class III violation, AHCA is authorized by law pursuant to §400.419 Fla Stat. (2001), to assess an administrative fine against Respondent in an amount of not less than $500 and not exceeding $1,000 for each violation. The facts and circumstances here warrant imposition of a fine of $500. 31. AHCA is not seeking assessment of a survey fee as to this violation. WHEREFORE, AHCA requests the following relief: 1. Entry of a Final Order that makes findings of fact, conclusions of law and a determination that under the facts as applied to the law, Respondent committed the violations alleged in this Administrative Complaint in Counts I, II and III; and 2. Imposition by such Final Order of a fine in the amount of $1,500.00 ($500 each as to the three counts); 3. Such other further general and equitable relief as may be appropriate. NOTICE Respondent hereby is notified that Respondent has a right to request an administrative hearing in this matter, pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to AHCA, Tom R. Moore, Esquire, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida, 32308. RESPONDENT IS FURTHER NOTIFIED if the request for hearing is not received by the Agency for Health Care Administration within twenty-one (21) days from the date of the Respondent’s receipt of the Administrative Complaint, a final order will be entered. Respectfully submitted this at Bay of September, 2002. AGENCY FOR HEALTH CARE ADMINISTRATION RAUCNAR by Tom R. Moore, Esquire Senior Attorney Fla. Bar. No. 097383 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) CERTIFICATE OF SERVICE AHCA, by and through its undersigned counsel, certifies that a copy of the above and foregoing Administrative Complaint, together with the accompanying Election of Rights for Administrative Complaint form and Explanation of Rights Under Sec. 120.569, F.S.A. form, have been forwarded by certified mail return receipt requested, to ALTERRA HEALTHCARE CORPORATION d/b/a ALTERRA WYNWOOD @F PALMER RANCH EAST, 5111 Palmer Ranch Parkway, Sarasota, Florida 34238, this 29"day of September, 2002. Agency for Health Care Administration ROW by Tom R. Moore, Esquire Senior Attorney Fla. Bar. No. 097383 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) 10

Docket for Case No: 02-004244