THE HEALTH CENTER PAGE 2/11 LI-YVBSO | Division of Administrative Hearings 1a/tarv2aa2 14:59 eqnad74a7g5 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINIS ~F | [ F D AGENCY FOR HEALTH CARE ADMINISTRATION, Date Petitioner, Vs. Case No, 200225571 THE HEALTH CENTER OF PENSACOLA, INC., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against THE HEALTH CENTER OF PENSACOLA, INC., pursuant to Sections 120.569, and 120.57, Florida Statutes, and alleges: NATURE OF THE ACTION 1. This is an action to uphold Respondent’s conditional licensure status. JURISDICTION AND VENUE 2. This tribunal has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. Venue shall be determined pursuant to Rule 28- 106.207, Fla, Admin. Code. LA/18F 2982 10:59 8504749795 THE HEALTH CENTER PAGE 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 II, Florida Statutes, and; Chapter 59A-4 Fla, Admin. Code, respectively. S. Respondent is a skilled nursing facility in the State of Florida, whose 180-bed nursing home is located at 8475 University Parkway, Pensacola, Florida 32514. Respondent is licensed as a skilled nursing facility license 4#5NF14130961; certificate number 9067, effective June 4, 2002. Respondent was at all time material hereto, a licensed facility under the licensing authority of AHCA, and was required to comply with all applicahle regulations, statutes and rules. COUNT I THE FACILITY PAILED TO LABEL DRUGS AND SBIOLOGICALS IN ACCORDANCE WITH CURRENTLY ACCEPTED PROFESSIONAL - PRINICFLES, AND FAILED TO INCLUDE THE APPROPRIATE ACCESSORY AND CAUTIONARY INSTRUCTIONS, AND THE EXPIRATION DATE WHEN APPLICABLE. 42 CFR 483.60(d)?7 SECTION 400.102(1) (dad), PLA. STAT. (2001); SECTION 400.23(7) (6), FLA. STAT. (2001); SECTION 400.23(8) (a), FLA. STAT. (2001); RULE 59A-4.112(5), FLA. ADMIN. CODE, AND; RULE 5S9A-4.1288, FLA. ADMIN. CODE UNCORRECTED CLASS TIT A3B/11 /20@2 18:59 8584749795 THE HEALTH CENTER PAGE 84/114 6. AHCA re-alleges and incorporates by reference paragraphs (1) through (5) above as if fully set forth herein. ?. AHCA surveyors conducted surveys of Respondent’ s facility between April 29, 2002 and May 3, 2002 and again on June 4, 2002. Staff interview, record review and surveyor observation brought to light the following: a). The following observations were made during the April 29-May 3, 2002 survey: 1. During medication pass on 4/29/02, the nurse was observed preparing 8 units of NPH insulin and 10 units of Regular insulin to administer to Resident #28. The nurse withdrew the insulin from another resident’s vials. 2. During medication pass on 4/30/02, the nurse was observed preparing 1 unit Albuterol and 1 unit Atrovent for Resident #29. The label read #% unit Albuterol 4% unit Atrovent. The nurse explained the order had been changed but the label had not. b). The following observations were made during the June 4, 2002 survey: L. Observation of the medication carts revealed that four vials of insulin were opened without an open date written on the insulin vial. 2. Miacalcin spray was also unlabeled. 3. Further inspection showed that four vials of insulin were opened more than 28 days ago. All contained labels with the statement “exp. After 28 days.” 1a/1aF2aa2 18:59 @5a4749795 THE HEALTH CENTER PAGE 5/11 8. Respondent's failure to label drugs and biologicals in acecerdance with currently accepted professional principles, and include the appropriate acceggory amd cautionary instructions, and the expiration date when applicable, is a violation of Rule 59A-4.1288, Fla. Admin. Code, which incorporates by reference 42 CFR 483.60(d). 9, Regpondent’s failure to label drugs and biologicals in accordance with currently accepted professional principles, and includa the appropriate accessory and cautionary instructions, and the expixation date when applicable, is a violation of Rule 59A-4.112(5), Fla. Admin. Code. 10. Respondent’s failure to label drugs and biologicals in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable, is an uncorrected class IIT deficiency as defined in Section 400.23(8) (c), Fla. Stat. Ll. The above constitutes grounds for the imposition of conditional licensure status, pursuant to Section 400.23(7) (b), Fla. Stat. 18/18/2982 1@:59 #9n4749795 THE HEALTH CENTER PAGE COUNT II THE FACILITY FAILED TO FOLLY INPLEMENT THE INFECTION CONTROL PROGRAM THEREBY PREVENTING THE POSSIBLE SPREAD OF INFECTIONS FOR 2 OF 4 WINGS. 42 CFR 483.65(a) (1)~(3); SECTION 400.102(1)(d), FLA. STAT. (2001); SECTION 400.22(8)(c), FLA. STAT. (2001), AND; RULE 59A-4.106(4) (1), FUA.ADMIN. CODE RULE 59A-4.1288, FLA. ADMIN. CODE UNCORRECTED CLASS IIT 12. AHCA re-alleges and incorporates by reference paragraphs (1) through (11) abeve as if fully set forth herein. 13. AHCA surveyors conducted surveys of Respondent’s facility between April 29, 2002 and May 3, 2002 and again on June 4, 29002. Staff interview, record review and surveyor observation brought to light the following: a). The following observations were made during the April 29-May 3, 2002 survey: 1. During medications pass observation revealed soiled enteral pumps with dried liquid food in rooms #261 and #262. The medication cart was soiled with dried liquid medication. 2. Medication pass on the D wing on 4/30/02 revealed a medication cart soiled with dried liquid medication. 3. Medication pass on 4/29/02 showed a nurse giving a subcutaneous injection to a resident without wearing gloves. 4. On 5/2/02 a nurse was observed caring for an incontinent resident without gloves. The murse turned and folded the soiled pad beneath the resident without gloves as well. b). The following observations were made during AB/11 1A/i8¢ 2002 14:59 s5Ad74a795 THE HEALTH CENTER PAGE A’/1i1 the June 4, 2002 survey: 1. Room #247 contained a cracked water pitcher lid. 2, Room #223 had a nasal cannula placed on top of a condenser with mo bag protecting the cannula from contamination. Alsa noted on the bedside table was a used glove. 3. Room #2618 had a bedside table that had dried residue across the entire top of the table. 4. In room #260, a syringe in a plastic bag was found to be hanging beside the enteral pump. The bag was undated. 5S. In room #349B, approximately 1 inch of water was observed to be in an open unlabeled syringe container on the bedside table of a bolus feeding PEG tube resident. 14. Respondent’s failure to fully implement the infection control program is a violation of Rule 59A-4.1288 Fla. Admin. Code, which incorporates by reference 42 CFR 483.65(a) (1)-(3). 15. Respondent’s failure to fully implement the infection control program is a violation of Rule 59;A- 4.106(4) (1), Fla. Admin. Code. 16. Respondent’s failure to fully implement the infection control program is an uncorrected class III deficiency as defined in Section 400.23 (8} (c), Fla. Stat. 17. The above constitutes grounds for the imposition of conditional licensure status, pursuant to Section 400.23(7) (b), Fla. Stat. 1a/lay2an2 14:59 85n4749795 THE HEALTK CENTER PAGE AB/11 CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief: 1. Factual and legal findings in favor of the Agency on Counts I and II, and; 2. Uphold the imposition of the conditional license dated June 4, 2002, original attached (Ex. 1). Respondent is notified that is 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, Plorida, 32308; Christine Thorson Messana, Senior Attorney. DISPLAY OF LICENSE Pursuant to Section 400.23(7)(e), Florida Statutes, the Center shall post the license in a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to the facility. 1A/1A/28a2 18:59 254749795 THE HEALTH CENTER PAGE AS/11 RESPONDENT IS FURTHER NOTIFIED THAT THE FATLURE 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 . Respectfully submitted. Dated this Wa aay of October, 2002. ce: Elizabeth Dudek he C. Deowek toe Christine Thorson Messana Fla. Bar. No. 0153818 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallanassee, FL 32308 (850) 922-5873 (office) (850) 413-9313 (fax) 1A/18/ 2082 14:59 85A4749735 THE HEALTH CENTER PAGE CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foragoing has been served by certified mail on this alten day of October, 2002 to: Joseph C. Ballay, Administrator, The Health Center of Pensacola, Inc, 8475 University Parkway, Pensacola, Florida 32514. fe 0. Deormek Tor Christine Thorson Messana THE HEALTH CENTER PAGE 11/2 IS ) T, S52906 '¥ ALWOLILLAG: Coal wale Mi ah Z00Z/PO/90 “ALLVC AN AaNORE fie athe Haley a Maat Ae VIOOVSNad PIsee ‘la iS Ayndag 2 ge a2 ag z6 AS 20 2b a A. :Zuraoyfo} sy ajerado 0} pozwouyne 2}AIDD: Ag ALITVNO HLIV3H ONY FV CADVNVW SO NOISIAIC NOLLVaLSININ I960CIVIANS °# ASNEO ik Raat TSA SENG, i OuSH)

Docket for Case No: 02-004250