STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ebb de STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, p 5 -¢] q 7 Petitioner, oO CASE NO: 2002046974 ~ vs. oe) = “7 a EDNA K. DURAN, o f” d/b/a GOLDEN SUNSET, ~ iT = © oo oO Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against EDNA K. DURAN, d/b/a GOLDEN SUNSET (hereinafter “Respondent”) and alleges the following: NATURE OF THE ACTION 1. This ig an action to impose an administrative fine on Respondent pursuant to Sections 400.419(1) (b, (1) (ce) and 400.419(9), Florida Statutes. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Section 120.569 and 120.57 Florida Statutes and Chapter 28-106 Florida Administrative Code. 3. AHCA, Agency for Health Care Administration, has jurisdiction over Respondent pursuant to Chapter 400 Part III, Florida Statutes. 4. Venue lies in Pasco County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28 Florida Administrative Code. PARTIES 5. Agency for Health Care Administration, State of Florida is the enforcing authority with regard to assisted living facility licensure law pursuant to Chapter 400, Part III, Florida Statutes and Rules 58A-5, Florida Administrative Code. 6. Respondent is an assisted living facility located at 5019 Magpie Drive, New Port Richey, FL 34652. 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 9675. COUNT I RESPONDENT FAILED TO ENSURE THAT ITS RESIDENTS WOULD BE FREE FROM STAGE THREE OR FOUR PRESSURE SORES IN VIOLATION OF Fla. Admin. Code R.58A-5.0181(1) (j) (2002); Fla. Admin. Code R.58A-5.0181(4) (2002) CLASS II DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. On or about August 26, 2002, a survey was conducted at Respondent’s facility. 9. Based on record review, the facility failed to ensure that residents were free of stage three or four pressure sores in one of eleven sampled residents (which included all seven current residents and four discharged residents). Findings were as follows: Documentation from the health care provider, documentation from the resident’s current placement and an interview with the administrator of Golden Sunset revealed that resident # 8 developed stage 3 and 4 pressure sores at the ALF due to the facility’s inability to provide appropriate care and services to meet the needs of this resident. The facility had no documentation of calls to the health care provider but an interview with the administrator and the admission notes by Dr. Usha Agarwal for the 01/27/02 admission of the resident to Community Hospital agree on the following: 1. Several calls were made to the doctor in December 01 and early January 02 regarding a decline in the resident’s condition. 2.. Complaints of loose stools, poor eating habits, poor mobility and a rash in the buttocks area were reported at different times and remedies were ordered. 3. Not until 01/27/02 was a decubitus reported and then it was one in the buttock area. The doctor in the admission report of 01/27/02 states the reason given for admission as the complaint of " not feeling good and not eating well and getting more and more lethargic." The doctor's exam revealed no decubitus in the buttock area, but multiple decubitus " in every pressure point you can name from the spine to the lower extremities". Hospital records stage and measure many of these as stage 3 and 4. 10. The above actions or inactions are a violation of Rule 58A-5.0181(4), Florida Administrative Code, which provides that the criteria for continued residency in a facility holding a standard, limited nursing services, or limited mental health license shall be the same as the criteria for admission except when the resident may be bedridden for up to seven consecutive days; when the resident requires care of a stage 2 pressure sore; when the resident is terminally ill and no longer meets the criteria for continued residency; and when the administrator is responsible for monitoring the continued appropriateness of placement of a resident in the facility. Rule 58A-5.0181(1) (j), Florida Administrative Code, requires that in order to be admitted to a facility holding a standard, limited nursing or limited mental health license, an individual must not have any stage 3 or 4 pressure sores. 11. The above referenced violation constitutes the grounds for the imposed Class II deficiency in that it directly threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (b), Florida Statutes, the Agency is authorized to impose a fine in the amount of two thousand dollars ($2,000). COUNT II RESPONDENT FAILED TO ENSURE THAT A RESIDENT WOULD BE DISCHARGED WHEN THE RESIDENT NO LONGER MET THE CRITERIA FOR CONTINUED RESIDENCY, OR THE FACILITY WAS UNABLE TO MEET THE RESIDENT’S NEEDS IN VIOLATION OF Fla. Admin. Code R.58A-5.0181(5) (2002); Section 400.426(8), F.S. (2002); Section 400.428(1), F.S. (2002) CLASS II DEFICIENCY 12. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 13. On or about August 26, 2002, a survey was conducted at Respondent’s facility. 14. Based on record review and interview with the facility administrator, Respondent failed to discharge resident when the resident no longer met the criteria for continued residency and the facility was unable to meet the resident's needs. Findings include: Resident # 8 was admitted on 08/06/99, The health assessment of 10/26/02 was missing the front page (this was the only health assessment available) but indicated that the resident had no decubiti at that time. Other documentation at the facility stated the resident would need assistance with transferring and ambulation in an emergency. According to an interview with the administrator, which is collaborated by documentation from the health care provider, there were increasing health care concerns during December of 2001 and early January 2002 but the condition of the resident’s skin was not noted by the facility, other than a "rash" in December 01, until the 01/27/02 admission to the hospital and then it was noted incorrectly and not even stated as a reason for the admission. Multiple decubitus were found that date by the doctor and many were staged by the hospital as stage 3 and 4. The facility did not properly assess the resident for continued residence in the ALF and had not been meeting the resident's needs, causing harm to the resident with a doctor's diagnosis of dehydration, decubitus ulcers and urinary tract infection and a prognosis that included " the patient is going to go downhill and probably die soon." 15. The above actions or inactions are a violation of Rule 58A-5.0181(5), Florida Administrative Code, which requires, in accordance with Sections 400.426(8) and 400.428(1), Florida Statutes, that the resident shall be discharged from a facility if the resident no longer meets the criteria for continued residency, or the facility is unable to meet the resident’s needs. 16. The above referenced violation constitutes the grounds for the imposed Class II deficiency in that it directly threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (b), Florida Statutes, the Agency is authorized to impose a fine in the amount of two thousand dollars ($2,000). COUNT III RESPONDENT FAILED TO PROVIDE CARE AND SERVICES APPROPRIATE TO THE NEEDS OF RESIDENTS ACCEPTED FOR ADMISSION TO THE FACILITY IN VIOLATION OF Fla. Admin. Code R. 58A-5.0182 (2002) CLASS II DEFICIENCY 17. AHCA re-alleges and incorporates paragraphs (1) through(6) as if fully set forth herein. 18. On or about August 26, 2002, a survey was conducted at Respondent’s facility. 19. Based on record review and interview, the facility failed to provide care and services appropriate to the needs of seven of seven current residents accepted for admission to the facility, and four of four discharged residents who were reviewed. Findings are as follows: 1. Resident # 8 was found to have suffered harm by a delay in reporting a significant change to the resident's health care provider. Resident # 8 developed stage 3 and 4 pressure sores at the ALF due to the facility’s inability to provide appropriate care and services to meet the needs of this resident, The facility had no documentation of calls to the health care provider. The doctor in the hospital admission report of 01/27/02 states the reason given by the facility for the admission as the complaint of “not feeling good and not eating well and getting more and more lethargic." The doctor's exam revealed multiple decubitus " in aa Rn eaeen i aetna tenant eee every pressure point you can name from the spine to the lower extremities". Hospital records stage and measure many of these as stage 3 and 4. 2. All residents were affected by the facilities lack of liability insurance. 3. All residents were affected by a lack of qualified administration and staff who failed to ensure that proper documentation was secured to provide appropriate care and services, failed to ensure that proper documentation was completed to assess residents for safety in emergencies, and failed to note significant changes in residents and to report these changes to family and the health care provider, thus exposing all residents to a lack of a safe and decent environment. 20. The above actions or inactions are a violation of Rule 58A-5.0182, Florida Administrative Code, which provides that an assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. 21. The above referenced violation constitutes the grounds for the imposed Class II deficiency in that it directly threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (b), Florida Statutes, the Agency is authorized to impose a fine in the amount of two thousand dollars ($2,000). COUNT IV RESPONDENT FAILED TO ENSURE THAT UNLICENSED PERSONS PROVIDING ASSISTANCE WITH SELF-ADMINISTERED MEDICATIONS RECEIVE A MINIMUM OF FOUR HOURS TRAINING IN VIOLATION OF Fla. Admin. Code R.58A-5.0191(5) (2002); Fla. Admin. Code R.58A-5.024(2) (a) (2002); Section 400.4256, F.S. (2002); Section 400.452, F.S. (2002) REPEAT CLASS III DEFICIENCY 22. AHCA re-alleges and incorporates paragraphs (1) through(6) as if fully set forth herein. 23. On or about May 10, 2002, a survey was conducted at Respondent’s facility. 24. The facility failed to ensure that documentation was available showing that all unlicensed persons providing assistance with self-administered medications had received a minimum of four hours of training prior to assuming this responsibility. 25. Based on record review and an interview with the administrator, it was determined that three of three unlicensed persons providing assistance with self-administered medications had not received a minimum of four hours of training prior to assuming this responsibility. 26. Respondent was provided a mandated correction date of June 10, 2001. 27. On or about August 26, 2002, a survey was conducted at Respondent’s facility. 28. The facility failed to ensure that documentation was available showing that all unlicensed persons providing assistance with self-administered medications had received a minimum of four hours of training prior to assuming this responsibility. 29. Based on record review and an interview with the administrator, it was determined that two of three unlicensed persons providing assistance with self-administered medications (Employee # 2 and 3), had not received a minimum of four hours of training prior to assuming this responsibility. 30. Said violation constitutes the grounds for the imposed repeat Class III deficiency in that it indirectly or potentially threatened the physical or emotional health, safety, or security of the facility’s residents. Pursuant to Section 400.419(1) (ec), Florida Statutes, the Agency is authorized to impose a fine in the amount of one thousand dollars ($1,000). 31. Pursuant to Section 400.419(9), Florida Statutes, AHCA is authorized to, in addition to any administrative fines, 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 the initial complaint investigations that result in the finding of a violation that was the subject of the complaint, or for monitoring visits conducted under 400.428(3) (c) to verify the correction of the violations. In this case, AHCA is authorized to assess a survey fee in the amount of three hundred dollars (5300). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration requests the Court to order the following: 1. Make factual and legal findings in favor of the Agency on Count I, Count II, Count III and Count IV; 2. Impose a fine and survey fee in the amount of seven thousand three hundred dollars ($7,300) for the violations cited in Count I, Count If, Count III and Count Iv against the Respondent, pursuant to Sections 400.419(1) (b), (1) (c) and 400.419(9), Florida Statutes; and 3. Any other general and equitable relief as deemed appropriate. The Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the attention of Katrina D. Lacy, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr. N., St. Petersburg, Florida, 33701. 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. Respectfully submitted, Katrina D. Lacy, Esqyire AHCA - Senior Attorney Fla. Bar No. 0277400 525 Mirror Lake Drive North, St. Petersburg, Florida 33701 I HEREBY CERTIFY that a true and foregoing has been furnished via U.S. Receipt No. 7002 2030 0002 7117 5843, Golden Sunset, 5019 Magpie Drive, New November Lav. , 2002. correct copy of the Certified Mail Return to Edna K. Duran, Owner, Port Richey, FL 34652 on atrina Copies furnished to: Edna K. Duran, Owner Golden Sunset 5019 Magpie Drive New Port Richey, FL 34652 (Certified U.S. Mail) Katrina D. Lacy AHCA ~ Senior Attorney 525 Mirror Lake Drive Suite 330G St. Petersburg, Fl 33701 Wendy Adams Agency for Health Care Administration 2727 Mahan Drive, Bldg #3 MS #3 Tallahassee, FL 32308 (Interoffice Mail) Alberta Granger AHCA, Assisted Living Facilities 2727 Mahan Drive, Bldg #3, MS Code #30 Tallahassee, Florida 32308 (Interoffice Mail) D. Lacy, Esquife GOLDEN SUNSET Assisted Living Facility E moos > 5019 Magpie Drive st New Port Richey, FL 3 Tot ub. ft Parte Divigiog.qhAdminisinative Hearings November 19,2002 From:Edna Duran/Her sae | [ E D To: State of Florida Agency for Healthc ay], 3 pee Administration Bale RECEIVED. | GENERAL COUNSEL ‘ bev 02 2002 Agency for Health Care Administration Dear Sir/Ma'am, I am just writting in response with the violations that been serve to me,and try to explain my side. I send proof on this alligations. My duty is to take good care of my residents and provide them the best care I could give and make them feel like home. I have been working with the elderly since 1987 until this date I love what I do and no intension to harm or neglect anyone,and will not break the law.Since I run my business since 1987 until now I follow the rules and never had any dime fines, I have some findings of course but I try to correct them as soon as I can. This alligations had been investigated numerous time by the agency for health care administration and as a result I had no:violations. This complaints had beed corrected by the agency for health care investigators, Believe me I was not treated good,but I deal with it live with it, and keep my business going and do the best I can to care for my residents and my children. It has been a long 10 months for me to keep hoping that wish this has to stop soon. I still visit the reidents that go to higher level of care,and one of them is resident no.8..I:. visit her at the nursing home once a week and I should not be responsible for what is happening to her 10 months down the road that had pass. It.was stated on count II alligation that she was going down hill and could die soon, I take care of her for 2 1/2 years she was not been harm or there were no health concern,The doctor see her and there were no orders of any concern. Please,let me know as soon as possible what are my next options,and what should I do next. at least if I could have a peace of mind with my children for the holidays. I appreciate for your response. Thank you very much, Sincerely, Copies furnished to: Katrina D.Lacy AHCA-Senior Attorney 525 Mirror Lake Drive Suite 3306 St.Petersburg,F1 33701 Wendy Adams Agency for Health Care Administration 2727 Mahan Drive,Bldg #3 MS # 3 Tallahassee,F1l 32308 Alberta Granger AHCA,Assisted Living Facilities 2727 Mahan Drive,Bldg #3 MS Code #30 Tallahassee,Florida 32308 _ oe A ; wes Viedicine Lonay ae - Cot ‘ ol a , Ted cose coe fe tible & bf ee sate east cn Wee Suge pau, OY \o J oe } Np. ke wae J Biers yea ms _ f WP Ha ety je ack Zef 1 \ HH b -4 J Ig \ a . t / | t mtu ‘ SquesTITUTION PERMIT TES DISPENSE AS WR TTEN Me 1 o%s/BAD Disp: 12/18/02 a/o1 oxig? 12/28/02 pr Agarwal, ssp 1% CREAM NDC: 49884-60075 Soo 9 3 t Ww ACQ: $3.32 is UKE g1i.97 cass NC Total Total: $9.00 Pas Pay? o73/BAD Disp: 12/38/02 g/or Orig: 12/28/01 F Evelyn pr Agarwal, Usha Golder Sunset House-Magpie D325 GRAND BLVD. WEW PORT RICHEY, NEW PORT RIC FL Dr DEAF BA-2822803 727-846-342 Qzy: vec $36.97 CASH NC

Docket for Case No: 02-004797