Division of Administrative Hearings STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRAGIO | STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Date — tl 9 5 iment Petitioner, AHCA NO: 2002049286 a ~ i « vs. O ry- [(Wd WESTMINSTER COMMUNITY CARE SERVICES, INC., d/b/a WESTMINSTER CARE OF ORLANDO, 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 WESTMINSTER COMMUNITY CARE SERVICES, INC., d/b/a WESTMINSTER CARE OF ORLANDO, (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the total amount of Two thousand dollars ($2,000) pursuant to Sections 400.102(1) (a) and (d), 400.022(3), and 400.23(8) (io), Florida Statutes. 2. The Respondent was cited for the deficiencies set forth below as a result of a follow-up survey on October 29, 2002, to the annual survey conducted on or about September 12, 2002. JURISDICTION AND VENUE 3. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. 4. Venue lies in Orange County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28-106.207 F.A.C. PARTIES 5. AHCA, is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part II, Florida Statutes and Rules 59A-4, Florida Administrative Code. 6. Respondent is a nursing home located at 830 West 29% Street, Orlando, FL 32805. The facility is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I RESPONDENT FAILED TO ENSURE THAT THE RESIDENT ENVIRONMENT REMAINED FREE OF ACCIDENT HAZARDS IN 2 WINGS ON THE 1ST FLOOR. VIOLATING RULE 59A-4,.1288, FLORIDA ADMINISTRATIVE CODE, INCORPORATING BY REFERENCE 42 CFR 483.25(h) (1), AND SECTION 400.141(8), FLORIDA STATUTES UNCORRECTED CLASS III DEFICIENCY 7. AHCA re-alleges and incorporates (1) through (€) as if fully set forth herein. 8. Based on observation, it was determined that the facility failed to ensure that the resident environment remained free of accident hazards in 2 of 4 wings on the first floor. 9. a) Specifically, the findings include: During the tour of the facility on 10/28/02, at 12:00pm, on the B Wing (the secured unit), the surveyor observed a disposable razor in a plastic bag laying on a shelf in an unoccupied resident room. The door to the room was open and was accessible to wandering residents. b) During the tour of the facility on 10/28/02 at 12:10pm, on the G Wing, the surveyor observed a small plastic cup of a brownish-yellow liquid sitting on a bedside table in a resident room. The liquid was not labeled and was in full view of other residents. 10. This is in violation of Rule 59A-4.1288, incorporating by reference 42 CFR 483.25(h) (1), and Section 400.141(8), Florida Statutes, that requires the facility ensure that the resident environment remains as free of accident hazards as is possible, and maintain the facility’s premises and conduct its operations in a safe manner. ll. The above referenced violation constitutes the grounds for the imposed uncorrected Class III deficiency and for which a fine of one thousand dollars ($1,000) is authorized under Sections 400.022(3), 400.102(1) (a,d), and 400.23(8) (c), Florida Statutes (2002). COUNT II RESPONDENT FAILED TO ENSURE THAT DRUGS WERE STORED IN LOCKED COMPARTMENTS ON THE H WING OF THE FACILITY. VIOLATING RULE 59A-4.112(6), AND RULE 59A-4.1288, FLCRIDA ADMINISTRATIVE CODE, INCORPORATING BY REFERENCE 42 CFR 433.60(e) UNCORRECTED CLASS III DEFICIENCY 12. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 13. Based on observation, it was determined that the facility failed to ensure that drugs were stored in locked compartments on the H Wing of the facility. 14. Specifically, the findings include: a) On 10/29/02 at 9:15AM, the surveyor entered the H Wing and observed a medication cart in the haliway outside of room 1007. The cart was unattended by the licensed nurse. The nurse was then observed walking down the hall toward the cart, entered a resident room, closed the resident room door and left the cart unattended again. The surveyor observed a bottle of liquid Augmentin and a bottle of liquid Amoxicillin sitting on top of the cart. A resident was in a wheelchair in front of the cart and reaching for something on the cart. This medication was left unattended and in full view of residents, staff and visitors. 15. This is in violation of Rule 59A-4.112(6), and Rule 59A-4.1288, Florida Administrative Code, incorporating by veference 42 CFR 483.60(e), that requires the facility to store drugs and non-prescription medication requiring refrigeration be stored in a separate, covered, waterproof, and labeled receptacle, and to provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse, except when the facility uses single unit package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected. 16. The above referenced violation constitutes the grounds for the imposed uncorrected Class III deficiency and for which a fine of one thousand dollars ($1,000) is authorized under Sections 400.022(3), 400.102(1) (a,d), and 400.23(8) (c), Florida Statutes (2002). 17. Notice was provided in writing to the Respondent of each of the above violation(s) and the time frame for corvection. CLAIM FOR RELIEF WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Counts I and II; B. Impose a fine of two thousand dollars ($2,000) for the violations cited in Counts I and II, against the respondert as authorized under Sections 400.102(1) (a,d), 400.23(8) (b), Florida Statutes; Cc. Attorney’s fees and costs and D. All other general and equitable relief allowed by law. NOTICE 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 Michael P. Sasso, Senior Attorney, Agency for Health Care Administration, 525 Mirror Lake Dr.,#330K, St. Petersburg, Florida, 33701. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WIL. RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, Wht pe heare- Michael P. Sasso, Esqu:re AHCA - Senior Attorney Fla. Bar No. 0167363 525 Mirror Lake Drive North St. Petersburg, Florida 33701 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to Michael J. Bittman, Registered Agent for Westminster Care of Orlando, 301 East Pine Street, Suite 1400, Orlando, FL 32801, via postage paid U.S. Mail, Return Receipt No. 7002 2030 0002 7109 5417 and to Diane King, Administrator, Westminster Care of Orlando, 830 West 29" street, Orlando, Florida 32805, Return Receipt No.7002 2030 0002 7109 5462, on January f4™, 2003. WichaD P Aga, Michael P. Sasso, Esquire Copies furnished to: Michael J. Bittman Registered Agent for Westminster Care of Orlando 301 Rast Pine St, Suite 1400 Orlando, FL 32801 (U.S. Certified Mail) Diane King, Administrator Westminster Care of Orlando 830 West 29° street Orlando, FL 32805 (U.S. Certified Mail) Michael P. Sasso, Esquire Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 3106 St. Petersburg, Florida 33701

Docket for Case No: 03-001165