STATE OF FLORIDA as is AGENCY FOR HEALTH CARE ADMINISTRATION Ky ee By Lys 4 4 4: A dj v/s / 3 AGENCY FOR HEALTH CARE 1Ohay! ye | ADMINISTRATION, AER IRA. IN Re Petitioner, vs. Case No. 2002046981 EVA M. LOWE, O>yOTKR d/b/a DESOTO CARE, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against EVA M. LOWE, d/b/a DESOTA CARE, hereinafter referred to as “Respondent,” pursuant to Sections 120.569, and 120.57, Florida Statutes (2001), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $500.00 against the Respondent, pursuant to Sections 400.419 and 400.414, Florida Statutes (2001). JURISDICTION AND VENUE 2. This tribunal has jurisdiction over the Respondent pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). 3. Venue shall be determined pursuant to Chapter 28-106.207, Florida Administrative Code (2001). PARTIES 4, Pursuant to Chapter 400, Part ITI, Florida Statutes, and Chapter 58A-5, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules. 5. The Respondent is an assisted living facility located at 2504 Southwest Baldwin Street, Nocatee, Florida 34268. The Respondent is and was at all times material hereto a licensed facility under Chapter 400, Part III, Florida Statutes (2001), and Chapter 58A-5, Florida Administrative Code (2001), having been issued license number 9846. COUNTI The Respondent failed to maintain an up-to-date Medication Observation Record for a resident. Fla. Admin. Code R. 58A-5.0185(5)(b) (2001) § 400.414, Fla. Stat. (2001) § 400.419, Fla. Stat. (2001) § 400.428, Fla. Stat. (2001) 6. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through five (5) above. 7. On or about January 7, 2002, AHCA conducted a survey at the Respondent’s facility. AHCA cited the Respondent for a deficiency, based on the findings below, to wit: a) Based on record review and interview the facility failed to maintain up to date Medication Observation Records (MOR) for three (3) residents (Residents #1, #2 and #4) of four (4) active sampled residents who receive assistance with self administration of medications. b) Observations on 1/07/02, of the medications for Resident #1, reveals a container of Tylenol PM with directors to give 2 each night. Review of the MOR for Resident #1 reveals that the Tylenol PM is not written on the MOR and there is no documentation that the resident has received the medication as ordered. c) Observations on 1/07/02, of the medications for Resident #2, reveals a container of Furosemide (Lasix) 20 mg. with directions to give once a day. Review of the MOR for Resident #2 reveals that the medication is not included on the MOR and there is no documentation that the resident has received the medication as ordered by the resident’s physician. d) Observation on 1/07/02, of the medications for Resident #4, reveals a bottle of Lipitor 20 mg. and a bottle of Zoloft 50 mg. each with directors to be taken once a day. Review of the Resident’s MOR reveals it does not include either medicine and there is no documentation that the resident received the medications o=as ordered. e) During interview on 1/07/02, the Administrator stated that the medications were given to the residents because she gives the medications and is familiar with each resident’s orders. The Administrator also stated that the medications did not get carried over to the January MORs from the December MORs. 8. The Respondent failed to maintain a daily up-to-date, medication observation record (MOR) for each resident, as required by Fla. Admin. Code R. 58A- 5.0185(5)(b) (2001). 9. The daily update of resident MORs is required, in pertinent part, as follows: (5) MEDICATION RECORDS...(b) For residents who receive assistance with self- administration or medication administration, the facility shall maintain a daily up-to- date, medication observation record (MOR) for each resident. A MOR must include the name of the resident and any known allergies the resident may have; the name of the resident’s health care provider, the health care provider’s telephone number; the name of each medication prescribed, its strength, and directions for use; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The MOR must be immediately updated each time the medication is offered or administered...” Fla. Admin. Code R. 58A-5.0185(5)(b) (2001) 10. _ For this deficiency, AHCA provided the Respondent a mandated correction date of February 7, 2002. I. On or about August 21, 2002, AHCA conducted a re-visit survey at the Respondent’s facility and made the findings below, to wit: a) Based on a review of two (2) Medical Observation Records (MOR) the facility failed to maintain an up to date MOR for 1 (Resident #1) of 2 residents reviewed. b) The MOR for Resident #1 showed the resident to be on four medications (Depakote, Risperdal, Remeron and Aricept). The Depakote and the Risperdal were listed to be given twice a day. The Remeron and the Aricept were to be given once a day at bedtime. 3 A review of the MOR during the survey showed that all the medications including the bedtime medications were already signed for. The pillbox still contained the evening medications. c) The bedtime medication of Aricept had been signed for and then circled and the word error written to correct the MOR. d) This documentation was shown to the Administrator who verified that the bedtime medications of Resident #1 had already been signed for, though the time had not yet come for the medications. 12. The Respondent failed to correct the cited deficiency by the mandated correction date. 13. The foregoing deficiency constitutes an uncorrected Class III deficiency, and warrants a fine of $500.00, to wit: “...(¢) Class III violations are those conditions or occurrences related to the operation and maintenance of a facility or the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class | or II violations. A Class III violation is subject to an administrative fine of not less than $500 and not exceeding $1,000 for each violation...” (§ 400.419(1)(c), Fla. Stat. (2001) WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the allegations of this count. 2. Impose a fine in the amount of $500.00, for the referenced violation. NOTICE The Respondent, EVA M. LOWE, d/b/a DESOTO CARE, is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights (two pages) 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; Attention: Lori Desnick, Senior Attorney. THE RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE ADMINISTRATIVE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY AHCA. Submitted on this DA), day of Octo ben 2002, on behalf of the Agency for Health Care Administration by, Lori Desnick, Senior Attorney Fla, Bar No. 0129542 Counsel for Petitioner Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, MSC# 3 Tallahassee, Florida 32308 (850) 922-8854 (office) (850) 413-9313 (fax) CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that the original Administrative Complaint, Explanation of Rights form, and Election of Rights form have been sent by U.S. Certified Mail, Return Receipt Requested (return receipt #7106 4575 1294 2049 8163), to Eva M. Lowe, d/b/a Desoto Care, 2504 Southwest Baldwin Street, Nocatee, Florida 34268, on this _ATtAday of October 2002. Ae Dorwrl. Lori Desnick, Esquire

Docket for Case No: 03-000782