Moy ib. EQ fl STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR ; HEALTH CARE ADMINISTRATION, a ’ DO-414> Petitioner, AHCA CASE NO.: 2002046980 VS. EDENBROOK- TALLAHASSEE, L.P., d/b/a EDENBROOK OF TALLAHASSEE, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by through the undersigned counsel, and files this Administrative Complaint against EDENBROOK-TALLAHASSEE, L. P. d/b/a ENDENBROOK OF TALLHASSEE (“Endenbrook of Tallahassee”), pursuant to Section 120.569, and 120.57, Florida Statutes, (2002), alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine against Edenbrook of Tallahassee, pursuant to Sections 400.419(1)(b); 400.4255(1)(a), 400.419(9), Fla. Stat. (2002), and Section 58A-5.0185(7)(c), and 58A-5.019(2)(b), Fla. Admin. Code, (2002). JURISDICTION AND VENUE 2 This agency has jurisdiction pursuant to 400, Part II] and Sections 120.569 and 120.57, Florida Statutes, (2002). 3. Venue lies in Leon County, Tallahassee, Florida, pursuant to Section 120.57, Florida Statutes, (2002); and 58A-5, Florida Administrative Code (2002), 28.106.207, Florida Administrative Code (2002). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 400, Part III, Florida Statutes, (2002), and Chapter 58A-5 Florida Administrative Code. 5. Edenbrook of Tallahassee is a for-profit corporation, whose 110-bed assisted living facility is located at 100 John Knox Road, Tallahassee, Florida. Edenbrook of Tallahassee is licensed as an assisted living facility license #AL9730; certificate number 11514, effective December 29, 2001 through December 27, 2003. Edenbrook of Tallahassee was at all times material hereto, a licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNT 1 EDENBROOK OF TALLAHASSEE FAILED TO ENSURE STAFF MENBERS OBSERVED DOCUMENTED AND REPORTED OBSERVATIONS OF RESIDENT STATUS FOR 1 OF 3 SAMPLED RESIDENTS(#2) STATE TAG-A524-MEDICATIONS STANDARDS Section 400.419(1)(b), Fla. Stat. (2002), VIOLATIONS; ADMINISTRATIVE FINES Section 400.4255(1)(a), Fla. Stat. (2002) USE OF PERSONNEL; EMERGENCY CARE 58A-5.019(2)(b), Florida Administrative Code (2002) STAFFING STANDARDS 6. AHCA tealleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about August 20, 2002, AHCA conducted a complaint investigation at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a.) During a complaint investigation conducted on August 20, 2002, Edenbrook of Tallahassee failed to ensure staff members observed, documented and reported observations of resident status for 1 of 3 sampled residents (#2). 8. The above constitutes a violation of Section 400.4255(1)(a), Fla. Stat. (2002), requires that persons under contract to the facility, facility staff, or volunteers, who are licensed according to part 1 of chapter 464, or those persons exempt under s. 464.022(1), and others as defined by rule, may administer medications to residents, take residents’ vital signs, manage individual weekly pill organizers for residents who self- administer medication, give prepackaged enemas ordered by a physician, observe residents, document observations on the appropriate resident’s record, report observations to the resident’s physician, and contract or allow residents or a resident’s representative, designee, surrogate, guardian, or attorney in fact to contract with a third party, provided residents meet the criteria for appropriate placement as defined in s. 400.426. Nursing assistants certified pursuant to part Il of chapter 464 may take residents’ vital signs as directed by a licensed nurse or physician. 9. The above constitutes a violation of Section 58A-5.019(2)(b), Fla. Admin. Code (2002), requiring that all staff be assigned duties consistent with his/her level of education, training, preparation, and experience. Staff providing services requiring licensing or certification must be appropriately licensed or certified. All staff shall exercise their responsibilities, consistent with their qualifications, to observe residents, to document observations on the appropriate resident’s record, and to report the observations to the resident’s health care provider in accordance with this rule chapter. 10. The violation alleged herein constitutes a Class II deficiency, and warrants a fine of $1,000.00. 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 $1,000.00. COUNT II EDENBROOK OF TALLAHASSEE FAILED TO CLARIFY AN AS NEEDED ORDER WITH THE PHYSICIAN FOR 1 OF 3 SAMPLED RESIDENTS (#2) STATE TAG A627-MEDICATION STANDARDS Section 400.419(1)(b), Fla. Stat. (2002), VIOLATIONS; ADMINISTRATIVE FINES Section 58A-5.0185(7)(c), Fla. Admin. Code (2002), MEDICATIONS LABELING AND ORDEREDS 11. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 12. On or about August 20, 2002, AHCA conducted a complaint investigation at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a.) During a complaint investigation conducted August 20 4, 2002, Edenbrook of Tallahassee failed to clarify an as needed order with the physician for 1 of 3 sampled residents (#2). 13. The above constitutes a violation of Section 58A-5.0185(7)(c), Fla. Admin. Code. (2002), requiring that if the directions for use are “as needed” or “as directed,” the health care provider shall be contacted and required to provide revised instructions. For an “as needed” prescription, the circumstances under which it would be appropriate for the resident to request the medication and any limitations, shall be specified; for example, “as needed for pain, not to exceed 4 tablets per day.” The revised instructions, including the date they were obtained from the health care provider and the signature of the staff who obtained them, shall be noted in the medication record, or revised label shall be obtained from the pharmacist. 14. The violation alleged herein constitutes a Class II deficiency, and warrants a fine of $1,000.00. 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 $1,000.00. COUNT Ill SURVEY FESS TOTALLING $500 PURSUANT TO Section 400.419(9), Fla. Stat. (2002) 15. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 16. This above constitutes a violation of Section 400.419(9), Fla. Stat. (2002), requires that in addition to any administrative fines imposed, the agency may assess a survey fee, equal to the lesser of one half of the facility’s biennial license and bed fee or $500, to cover the cost of conducting initial complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits conducted under s. 400.428(3)(c) to verify the correction of the violations. WHEREFORE, AHCA demands the following relief: 1. Impose a fine in the amount of $500.00 The above constitutes a violation of 400.419(1)(b), Fla. Stat. (2002), provides that class II violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than class I violations. A class II violation is subject to an administrative fine in an amount not less than $1,000 and not exceeding $5,000 for each violation. A citation for a class II violation must specify the time within which the violation is required to be corrected. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2002). 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 O. Mathis, Senior Attorney. RESPONDENT IS FURTHER NOTIFED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL REASULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully Submitted this (2 (2... of forern hey 2002, Leon County, Tallahassee, Florida. Aareiete nce Michael O. Mathis Fla. Bar. No. 0325570 Counsel of Petitioner, Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0055 (office) (850) 413-9313 (fax) Donah Heiberg 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 /~ day of fever be 2002 to Marcia Kay Jensen-Waller, Administrator, Eldenbrook of Tallahassee, 100 John Knox Road, Tallahassee, Florida 32303. Michael ©. Mathis, Esq.

Docket for Case No: 02-004793