STATE OF FLORIDA : . AGENCY FOR HEALTH CARE ADMINISTRATION LPs 93 We ae. AGENCY FOR HEALTH CARE (Spy, ADMINISTRATION, LY ol OS Petitioner, eth vs. Case No. 2003001725 ALTERRA HEALTHCARE CORPORATION, 0% SGD d/b/a ALTERRA WYNWOOD OF PALMER RANCH EAST, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against ALTERRA HEALTHCARE CORPORATION, d/b/a ALTERRA WYNWOOD OF PALMER RANCH EAST, hereinafter referred to as “Respondent,” pursuant to Sections 120.569, and 120.57, Florida Statutes (2002), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $750.00 against the Respondent, pursuant to Sections 400.414, 400.419(1)(c), and 400.428, Florida Statutes (2002); and Rule 58A-5.0185(7)(d), Florida Administrative Code (2002). 2. The Respondent was cited for the deficiency during the biennial survey for an Extended Congregate Care (ECC) and Limited Nursing Service (LNS) conducted on or about February 24, 2003. The deficiency cited was a repeat Class III deficiency from survey's for an Extended Congregate Care (ECC) and Limited Nursing Service (LNS) on or about November 20, 2001 and August 5, 2002. JURISDICTION AND VENUE 3. This tribunal has jurisdiction over the Respondent pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). 4. Venue shall be determined pursuant to Chapter 28-106.207, Florida Administrative Code (2002). PARTIES 5. Pursuant to Chapter 400, Part III, Florida Statutes (2002), and Chapter 58A-5, Florida Administrative Code (2002), AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules. 6. The Respondent is an assisted living facility located at 5111 Palmer Ranch Parkway, Sarasota, Florida 34238. The 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 (2002), having been issued license number 9737. COUNT I The Respondent failed to ensure that changes in medication directions have an order from a physician, failed to ensure that use of medications as they appear on the label was the same as on the Medication Administration Observation Record, and failed to obtain medication orders and place new directions for the medication on the resident’s Medication Observation Record violating Fla. Admin. Code R. 58A-5.0185(7)(d) (2002) 7. AHCA repeats, re-alleges, and incorporates paragraphs one (1) through six (6) as if fully set forth herein. 8. On or about November 20, 2001, AHCA conducted a biennial Extended Congregate Care (ECC) and Limited Nursing Services (LNS) survey at the Respondent’s facility. AHCA cited the Respondent for a deficiency, based on the findings below, to wit: a) b) 9. 10. Resident #7 had an order on MOR that read, “Aricept 5 mg. tab, take % tablet by mouth every night at bedtime.” The MOR revealed that the nurses were administering the medication at 5 P.M. The resident also had an order for Paxil 10 mg. Tab, take 1 % tablets by mouth at bedtime. It was also being administered at 5 P.M. Resident #8 had an order for, “Aricept 10 mg. tab, take | tablet by mouth every night at bedtime.” The medication was signed out at 5 P.M. on a daily basis from November 1" to the 18" on the MOR. Interview with the Resident Health Coordinator on November 20, 2001 revealed, “The orders were for HS (hour of sleep) and bedtime was early in the Alzheimer’s Unit, but dinner in the facility was at 5:15 P.M.” The foregoing deficiency constitutes a Class III deficiency. For this deficiency, AHCA provided the Respondent a mandated correction date of December 10, 2001. 11. On or about January 31, 2002, AHCA conducted a revisit survey at Respondent’s facility. The deficiency cited in paragraphs 8 and 9 above, was noted as corrected at that time. 12. On or about August 5, 2002, AHCA conducted a biennial Limited Nursing Services (LNS) and Extended Congregate Care (ECC) survey at the Respondent’s facility and made the findings below, to wit: a) 13. 14. Resident #4’s MOR indicated the following medication: “Lotrisone cream qid (four times a day) under tummy fold, buttock cheeks.” Two tubes were located for this resident. One of the labels stated the cream was to be used TID (three times a day). There was no label alert noted on this tube. The foregoing deficiency constitutes a repeat Class III deficiency. For this deficiency, AHCA provided the Respondent a mandated correction date of September 5, 2002. 15. On or about September 25, 2002, AHCA conducted a revisit survey at Respondent’s facility. The deficiency cited in paragraphs 12 and 13 above, was noted as corrected at that time. 16. On or about February 24, 2003, AHCA conducted an Extended Congregate Care (ECC) and Limited Nursing Services (LNS) survey at the Respondent’s facility. AHCA cited the Respondent for a repeat violation, based on the findings below, to wit: a) Review of Resident #2’s progress notes for the month of February 2003, revealed the following weekly notes, “2/17/03, wkly (weekly) note. ..meds crushed, given in applesauce,” “2/12/02, wkly note...meds crushed, given in applesauce,” “2/5/02, wkly note...meds crushed, given in applesauce.” Further review revealed a doctors order dated November 24, 2000, “ASA (aspirin) 81 mg., 1 tab qd (every day). May crush med.” b) Review of Resident #2’s MOR for the month of February, 2003 revealed the current medications for the resident to include, Glucotrol, 7.5 m.g., 1 tab qd, ASA 81 mg., 1 tab qd (crush), Isosorbide Mono, 325 mg. EG, 1 tab qd, and Metroprolol, 25 mg., 1 tab qd (hold if pulse less than 60). c) Interview with the Licensed Practical Nurse (LPN) revealed the resident’s medications are crushed and did not obtain a doctor’s order for the medications to be crushed. 17. The Respondent failed to obtain medication orders to crush resident’s medications and place new medications and place new directions for the crushed medications on the resident’s MOR for one (1) (Resident #2) of four (4) sampled residents, which is not in compliance with Rule 58A-5.0185(7)(d), Florida Administrative Code (2002). 18. Medication standards for ALF residents are regulated, in pertinent part, as follows: “$8A-5.0185 Medication Practices...(d) Any change in directions for use of a medication for which the facility is providing assistance with self-administration or administering medication must be accompanied by written medication order issued and signed by the resident’s health care provider, or faxed copy of such order. The new directions shall promptly be recorded in the resident’s medication observation record. 4 The facility may then place an “alert” label on the medication container which directs staff to examine the revisited directions for use in the MOR, or obtain a revised label from the pharmacist.” (Fla. Admin. Code R. 58A-5.0185(7)(d) (2002)) 19. The foregoing deficiency constitutes a repeat Class III deficiency, and warrants a fine of $750.00, to wit: “(c) Class III violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class I or class 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. (2002)) 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 $750.00, for the referenced violation. Submitted on this [7 Beay of May 2003. Fla. Bay. No. 0504149 Counsel for Petitioner Agency for Health Care Administration 525 Mirror Lake Dr., 3” Fl. St. Petersburg, Florida 33701 (727) 552-1439 (office) (727) 552-1440 (fax) NOTICE The Respondent, ALTERRA HEALTHCARE CORPORATION, d/b/a ALTERRA WYNWOOD OF PALMER RANCH EAST, 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: Lealand McCharen, Agency Clerk, Agency for Health Care Administration, Building #3, MS #3, 2727 Mahan Drive, Tallahassee, Florida, 32308. Telephone: (850) 922- 5873. THE RESPONDENT IS FURTHER NOTIFIED, IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. CERTIFICATE OF SERVICE I HEREBY CERTIFY that the original Administrative Complaint, Explanation of Rights form, and Election of Rights forms have been sent by U.S. Certified Mail, Retum Receipt No: 7002 2030 0007 8499 6997, to Administrator, Alterra Wynwood of Palmer Ranch East, 5111 Palmer Ranch Parkway, Sarasota, Florida 34238 and CT Corporation System, Registered Agent for Alterra Healthcare Corporation, 1200 South Island Road, Plantation, Florida 33324 by U.S. Mail. Lv Submitted on this /7 “day of M Eileen O’Hara Gaycia, Senior Attorney Copies to: Administrator Alterra Wynwood of Palmer Ranch East 5111 Palmer Ranch Parkway Sarasota, Florida 34238 (U.S. Certified Mail) CT Corporation System Registered Agent for Alterra Healthcare Corporation 1200 South Island Road Plantation, Florida 33324. (U.S. Mail)

Docket for Case No: 03-002563

Orders for Case No: 03-002563