10/14/02 19:48 FAX . , 1D28588716367 LA-YAVF i 19-10-02 19:46 EMERALD SHORES EMERALD SHORESO Division of Administrative Hearings STATE OF FLORIDA AGENCY FOR HEALTH CARE'ADMINISTRATI AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, YS. Case No, 2002045446 EMERALD SHORES HEALTH CARE ASSOCIATES, LLC, D/B/A EMERALD SHORES HEALTH AND REHABILITATION, Respondent. ADMINISTRATIVE COMPLAINT. COMES NOW the AGENCY FOR HEALTH ‘CARE ADMINISTRATION (hereinatter’ “AHOCA” or “the Agency”), by and through the undersigned counsel, and files this Administrative Complaint against EMERALD SHORES HEALTH CARE ASSOCIATES, LLC., D/B/A EMERALD SHORES HEALTH AND REHABILITATION, (hereinafter “Respondent” or “the facility”) pursuant to Sections 120.569, and 120.57, Florida Statutes., and alleges: . NATURE OF THE ACTION 7 1. This is an action to impose an administrative fine in the amount of $6,000 against Respondent, pursuant to Section 400.102, Florida Spatutes, and assess costs related to the investigation and prosecution of this case, pursuant to Section 400.121(10), Fla. Stat, JURISDICTION AND VENUE i | 2. This tribunal has jurisdiction pursuant to! Sections 120.569 and 120.57, Florida Stanates. 003 10/44/02) 15:48 FAX — -- _ Pasv1it 19-19-92 19:46 EMERALD 5HOR 1D"850871 6967 Es EMERALD SHORESO 3. Venue shall be determined pursuant to Rule 28-106.207, Fla. Admin. Code. PARTIES 4. AHCA is the regulatory agency responsible for licensure of nursing homes and enforcement of all applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended); Chapter 400, Part I, Florida Statutes, and; Chapter 594-4 Fla, Admin, Code, respectively. 5, Respondent is a skilled nursing facility in the State of Florida, whose 77-bed nursing home is located at 626 North Tyndall Parkway, Calloway, Florida 32404, Respondent is licensed as a skilled nursing facility license #SNF1292096. Respondent was at all times material hereto, a licensed facility under the licensing authority of AHCA, and was required to comply with all applicable regulations, statutes and rules. Count I THE FACILITY FAILED TO PROMOTE CARE FOR RESIDENTS IN A MANNER AND ENVIRONMENT THAT MAINTAINED THE DIGNITY OF THE FACILITY RESIDENTS 42 CFR 483.15; Section 400.102(d), Florida Statutes; Section 400.022(1)(n), Florida Statutes; Section 400.23(8)(c), Florida Statutes; Section 400.121(10), Florida Statutes, and; Rule 59.4-4.1288, Fila, Admin. Code. 6, AHCA re-alleges aud incorporates by reference paragraphs (1) through (5) as if fully set forth herein. 7, AHCA surveyors conducted an annual survey of Respondent’s facility on June 3-6, 2002. Surveyor observation brought to light the following: a). Resident #2 was observed on 6/4/02 at 1:20 PM wearing a gown that had the resident's name and room number written on the front left chest in Jarge letters approximately 1 1/2 inches high with a permanent marker. ood 10/14/02 45:49 FAX = ~ peq7il 19-19-92 19:46 EMERALD SHORES EMERALD SHORESO 1D=8508716367 b)}. A Heensed practical nurse (LPN) was observed standing up while feeding Resident #11 in the main dining room on 6/3/02 at 12:45 PM. On 6/4/02 at 12:40 PM, a certified nursing assistant (CNA) was observed standing up while feeding the sare resident. c). During the lunch observation in the main ding room on 6/3/02 at 12:49 PM, the same LPN was observed standing up while feeding Resident #17. 8. AHCA surveyors conducted a follow-up survey of Respondent’s facility on July 12, 2002. Resident interview and surveyor obseryation brought to ight the following: a). On 7/12/02, surveyors observed lunch trays served starting at 12:25 PM, with the last tay served at 12:57 PM. Residents at same the tables were served at different times, with one resident waiting for 22 minutes for his/her meal after the first resident at the table had been served. b). During a confidential interview with one of the residents on 7/12/02 at 12:40 ¥M about waiting for other residents to be served, the resident stated; "I don't like it, because no one else gets to eat." 9. Respondent’s failure to treat facility residents with respect and dignity violates 42 CFR 483.15. 10. Respondent’s failure to treat facility residents with respect and dignity violates Section 400,022(1}(h), Florida Statutes. 11. Respondent’s failure to treat facility residents with respect and dignity violates Rule 594-4, 1288, Fla. Admin. Code. 12. Respondent’s failure to treat facility residents with respect and di emty is an uncorrected or repeat Class IT deficiency as defined by Section 400.23(8)( ¢), Florida Statutes, __ and constitutes grounds for the imposition of a $2,000 administrative fine pursuant to Section 400.102(¢), Florida Statutes, Respondent was cited for one or more Class I or Class son deficiencies at the annual survey conducted June 3-6, 2002. 13. The Agency may assess costs related to the investigation and prosecution of this case, pursuant to Section 400.121(10), Florida Statutes. Count If oo0s Pe5s/ii 10/14/02 15:49 Fax ID=B508716367 19-19-92 19:47 EMERALD SHORES EMERALD SHORESO THE FACILITY FAILED TO ENSURE THAT RESIDENTS WERE FREE OF ANY SIGNIFICANT MEDICATION ERRORS. 42 CFR 483.25(M)(2); SECTION 400,102(A) & (D), FLORIDA STATUTES; SECTION 400.23(8)(C), FLORIDA STATUTES} SECTION 400,022(1)(L), FLORIDA STATUTES; SECTION 400.121(10), FLORMaA STATUTES , AND; RULE 59A4-4.1288, FLA. ADMIN. CODE. 14. AHCA re-alleges and incorporates by reference paragraphs (1) through (13) as if fully set forth herein. 15. AHCA surveyors conducted an annual survey of Respondent’s facility on June 3-6, 2002. Staff interview, record review and surveyor observation brought to light the following: a). Record review on 6/4/02 showed that Resident #3 received the anti-depressant medication Prozac since admission to the facility. The psychiatrist's notes |dated 2/6/02 state that the resident’s medication was changed from Prozac 20 : milligrams (mg) every a.m. to Celexa 20 mg every day. The psychiatrist's dated 3/15/02 state there is a duplication in anti-depressant therapy, to reduce the Celexa to 10 mg every a.m. for 5 days, then to discontinue the Celexa but to continue the Prozac 20 mg every am. notes b). Review of Resident #3’s Medication Administration Records (MARS) jfor the months of February and March showed that the resident continued to receive both the Prozac and the Celexa. The MARS also showed that both drugs were discontinued on the same day, ¢). During an interview on 6/4/02 at 3:45 p.m., Registered Nurse emplayed by the facility disclosed that Resident #3 had been given both medications and that in March the Prozac had been discontinued in error. d). The physician was called and an order to restart the Prozac was given on a 6/4/02. 16. AHCA surveyors conducted a follow up survey of Respondent’s facility on July 12, 2002. Staff interview, record review and surveyor observation brought to light the following: a). A clinical record review was conducted for Resident #4 on 7/12/02. .There was a physician order dated 7/1/02 for Zocor one tablet orally every day. Resident #4’s Medication Administration Record (MAR) for July 2002 indicated that one Zocor tablet orally had been administered daily up until 7/12/02. 10/14/02 15:49 FAX . _ i o06 19-18-92 19:47 EMERALD SHORES EMERALD SHORESO 1D=8508716367 PSS/11 b). Upon surveyor inspection conducted on 7/ 12/02 at 10:00 AM central time, surveyors discovered that the resident did not have a prescription available for Zocor but had a box of 9 Lipitor. c). An interview was conducted with the Licensed Practical Nurse on 7/12/02 at 250 PM CST, He stated he had been giving the resident the Lipitor because "that's what they sent,"; he did not report the discrepancy to the pharmacy. 17. Respondent’s failure to ensure that facility residents were free of any significant medication errors violates 42 CFR 483.25(m)(2). ) 18, Respondent’s failure to ensure that facility residents were free of any significant medication errors violates Section 400.022(1)(), Florida Statutes. 19, Respondent’s failure to ensure that facility residents were free of any significant medication errors violates Rule 59A4.1288, Fla. Admin. Code. 20, Respondent’s failure to ensure that facility residents were free of any significant medication errors is an uncorrected or repeat class II deficiency as defined by Section 400.23(8) (c), Florida Statutes, and constitutes grounds for the imposition of a $2,000 administrative fine pursuant to Section 400,102(1)(a) and (d), Florida Statutes. Respondent was cited for one or yaore Class J or Class I deficiencies at the annual survey conducted June 3-6, 2002. 21. The Agency may assess costs related to the investigation and prosecution of this case, pursnant to Section 400,121(10), Florida Statules. Counr ig THE FACILITY FAILED TO PROVIDE THE NECESSARY THERAPEUTIC DIET AS PRESCRIBED BY THE RESIDENT’S PHYSICIAN, 42 CFR 483.35(e); 42 CFR 483.25(D(2); Section 400.022(1)()), Florida Statutes; Section 400,102(a) & (d), Florida Statutes; Section 400.23(8)(c), Florida Statutes; Section 400,121(18), Mlorida Statutes; and Rule 59A-4,1288, Fla. Admin, Code 22. AHCA. re-alleges and meorporates by reference paragraphs (1) through (21) as if 10/14/02 15:50 FAX oor 18-16-82 19:47 EMERALD SHORES EMERALD SHORESO 1D=85887168367 Pa7T/il fully set forth herein. 23. AHICA surveyors conducted an annual survey of Respondent’s facility on June 3-6, 4002. Record review and surveyor observation brought to light the following: a). Resident #9’s record review showed a physician's order for a mechanical soft diet with no added salt and no concentrated sweets. The resident's diet card observed on 6/3/02 coincided with the doctor's order. b). During lunch on 6/3/02 at 12:45 PM, surveyors observed a dietary aide adding salt to Resident #9’s food. During dinnex observation on 6/4/02 at 6:00 PM, surveyors saw an opel salt packet on table next to Resident #9’s food and galt on the resident's food. 24. ATICA surveyors conduated a follow up survey of Respondent’s facility on July 12, 2002. Record review and surveyor observation brought to light the following: a). Surveyors observed Resident #9 being fed a pureed meal of fish, coleslaw, otatoes, hush puppies, pic, tea, water, pie and fat free milk, during lunch on. 7/12/02 at 12:40 PM. The entire meal was observed. b). Resident #9’s diet card read " NCS Pureed diet" (non-concentrated sweets). The current physician's order for the resident stated that the facility was supposed to give the resident a sugar free milkshake at lunch. c): Review of the resident's menu for NCS diet listed milk choice "AD" (as desired), Resident #9 Jost eleven pounds since Jamiary 2002; getting fat free milk, instead of the prescribed milkshake necessary for weight gain. 25, Respondent’s failure to provide Resident #9’s therapeutic diet as prescribed by the resident's physician violates 42 CFR 483.35(e) and 42 CFR 483.25()@). 26, Respondent’s failure to provide Resident #9"s therapeutic diet as prescribed by the resident’s physician violates Section 400.022(1)(), Florida Statutes. 27. Respondent's failure to provide Resident #9’s therapeutic diet as prescribed by the resident’s physician violates Rule 59A-4.1288, Fla, Admin. Code. 28. Respondent’s failure to provide Resident #9’s therapeutic diet as prescribed by the resident's physician is an uncorrected or repeat Class I deficiency as defined by Section 400.23(8)( c ), Florida Statutes, and constitutes grounds for the imposition of a $2,000 10/44/02 15:50 FAX ; . _. Buos 18 -1@-82 19:48 EMERALD SHORES EMERALD SHORESO 1D=8598716367 administrative fine pursuant to Section 400.102(1)(a) and (4), Florida Statutes. Respondent was cited for one or more Class I or Class I] deficiencies at the annual survey conducted June 3-6, 2002. 29. The Agency may assess costs related to the investigation and prosecution of this case, pursuant to Section 400.121(10), Florida Statutes. CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief 1). Factual and iegal findings in favor of the Agency on Counts I through IM; 2). Imposition of $6,000 in administrative fines, and; 3). Uphold the imposition of costs related to the investigation and prosecution of this case, pursuant to section 400.121(10), Florida Statutes. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569 and 120.57, Florida Statutes, Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida, 32308; Christine Thorson Messana, Senior Attorney, Ppeg/il 10/14/02 15:50 FAX . . @oog RESO 1D=8588716367 Ppegvil 19-19-82 19:48 EMERALD SHORES EMERALD SHO RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A BEARING 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, Dated this Staayor Ochoa 2002. Respeotfully submitted, istine Thorson Messana Fla. Bar No. 0153818 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC#3 3727 Mahan Drive Tallahassee, FL 32308 (850) 922-5873 (office) (850) 413-9313 (fax) cet Elizabeth Dudek CERTIFICATE OF SERVICE THEREBY CERTIFY that a tme and correct copy of the foregoing has been served by certified mail on this SAU dayof_C -Lelaey. __, 2002 to; EMERALD SHORES HEALTH CARE ASSOCIATES, LLC., D/B/A EMERALD SHORES HEALTH AND REHABILITATION, 626 North Tyndall Paz , Calloway, Fl istiné Thorson Messana &

Docket for Case No: 02-004249