STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2003004565 NEW BEGINNINGS BY JOANNE PRETTYMAN, Respondent . / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against NEW BEGINNINGS BY JOANNE PRETTYMAN (hereinafter “Respondent”), pursuant to Section 120.569, and 120.57, Florida Statutes(2002), and alleges: NATURE OF THE ACTION 1. This is an action to impose administrative fines on Respondent pursuant to Section 400.419(1) (c), Florida Statutes (2002). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Section 120.569 and 120.57, Florida Statutes (2002) and Chapter 28-106, Florida Administrative Code (2002). 3. AHCA, Agency for Health Care Administration, has jurisdiction over Respondent pursuant to Chapter 400, Part III, Florida Statutes (2002). 4. Venue lies in Lee County, Division of Administrative Hearings, pursuant to Section 120.57, Florida Statutes (2002), and Chapter 28, Florida Administrative Code (2002). PARTIES 5. The Agency is the regulatory agency responsible for licensure of assisted living facilities and enforcement of all applicable federal regulations, state statutes and rules governing assisted living facilities pursuant to Chapter 400, Part III, Florida Statutes (2002) and; Chapter 58A-5 Fla. Admin. Code (2002), respectively. 6. New Beginnings operates a 25-bed assisted living facility located at 2885 Janet Drive, North Fort Myers, Florida 33903, and is licensed as an assisted living facility, having been issued license number 6109. 7. New Beginnings was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. COUNT I RESPONDENT FAILED TO MAINTAIN A DAILY UP-TO-DATE MEDICATION OBSERVATION RECORD (MOR) FOR EACH RESIDENT WHO RECEIVES ASSISTANCE WITH SELF-ADMINISTRATION OR MEDICATION ADMINISTRATION. Fla. Admin. Code R.58A-5.0185(5) (b) (2002) 8. The Agency re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. FIRST REPEAT CLASS III DEFICIENCY 9. On or about July 30, 2001, a complaint survey was conducted at Respondent’s facility. 10. Based on staff interview and a review of six of fifteen resident Medication Observation Records (MOR), it was determined that Respondent failed to ensure that these records were up-to-date by signing off on the MOR when the residents received their medications. ll. This investigation started at approximately 10:30 A.M. and the morning medications were already given out to the residents. The following is a list of residents' MOR’s that were not up-to-date. a. A review of Resident #1's MOR showed that she is to take Hydroxyz twice a day at 9:00 A.M. and 9:00 P.M. There was no documentation that the patient had been given her medication at 9:00A.M,. Staff interview revealed that the patient had been given the medication, but the MOR had not been initialed to indicate that the medication had been given. b. Review of Resident #2's MOR showed that he is to take Depakote at 9:00 A.M. and 9:00 P.M. There was no documentation to show he took this medication on 7/28, 7/29 and 7/30. He takes Zyprexa and Vistaril every night at 9:00 P.M. The MOR showed he did not take these medications on 7/28 and 7/29. He also takes Thorazine every night. However, the MOR shows he has not taken this medication since 7/24/01. Interview with staff stated he is not sure if the resident has taken these medications or not. c. Resident #3's MOR showed she is to take Dilantin at 9:00 A.M. and 9:00 P.M. everyday. There is no documentation to indicate whether the resident took this medication at 9:00A.M. Staff stated he gave the medication to Resident #3, but did not document it. d. Resident #4's MOR showed that she is to take Fluphenazine three times a day. There is no documentation to indicate whether the resident took the medication at 9:00 A.M. Staff stated he gave the medication to her, but did not document ait. e. A review of Resident #5's MOR showed that she takes Carbamazepine three times a day. There is no documentation to indicate whether the resident took the medication at 9:00 A.M. Staff stated he gave the medication to the resident, but did not document it on the MOR. f. Resident #6's MOR was not updated. The resident is to take Benztropine and Trifluoperazine at 9:00 A.M. and 9:00 P.M. There is no documentation to indicate whether she received these medications at 9:00 A.M. She is to take Buspirone three times a day. The MOR shows she has not had this medication since 7/24/01. She also takes Sulindac at 9:00 A.M. and 9:00 P.M. There is no documentation on the MOR to indicate whether she has taken this medication since 7/25/01. 12. Staff concedes that the MOR’s are inaccurate and stated that they will be fixing them for the next month. 13. Respondent was provided a mandated correction date of August 30, 2001. 14, On or about October 22, 2001, the Agency conducted a complaint follow-up survey. The deficiencies cited at the July 30, 2001 survey had been corrected at that time. 15. On or about March 24, 2003, a complaint survey visit was conducted at Respondent’s facility. 16. Based on a review of the Medication Observation Record (MOR) and interview with staff, it was determined that Respondent failed to maintain a daily up-to-date MOR for one of one (Resident #1) residents reviewed. 17. Review of the MOR for Resident #1 revealed that on March 3, 2003, the medication Phenytoin Sodium ER 100 mg. (milligrams) was documented as not given at 1:00 P.M. The reason noted was "out of medication." Further review of the MOR revealed that the 9:00 P.M. dose of the medication was signed as given to the resident. On March 4, 2003, the 9:00 A.M. medication was again noted as not given due to the facility being out of the medication. 18. Interview with staff revealed that the evening staff signed the medication as given, even though the facility did not have the medication. 19. The above actions or inactions are a violation of Rule 58A-5.0185(5) (b), Florida Administrative Code (2002), which requires the facility to maintain a daily up-to-date, medication observation record 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. 20. Respondent was provided a mandated correction date of April 24, 2003. 21. On or about May 5, 2003, the Agency conducted a complaint follow-up survey. The deficiencies cited at the April 24, 2003 survey had been corrected at that time. SECOND REPEAT CLASS III DEFICIENCY 22. On or about June 16, 2003, a Biennial survey was conducted at Respondent’s facility. 23. Based on Medication Observation Record (MOR), review of resident’s medication prescription label, and staff interview, Respondent failed to ensure that the MOR’s are up-to- date for one (1) of three (3) sampled residents. Findings: 1. Review of resident #2's June, 2003 MOR revealed the medication Glucotrol XL, 10mg, 1 tab bid (twice a day) documented on the MOR. Review of the pharmacy label of the resident’s medication, Glucotrol XL, documented to hold the medication if the resident's bs (blood sugar) was less than 100. The June 2003 MOR lacked documentation noting to hold the residents medication if the bs was less than 100. Further review of the prescription label revealed the resident's vital signs and weights to be done 2 times a week. There was no documentation of the resident's blood sugars daily, nor was there documentaion of the resident's vital signs and weights being done 2 times a week. 2. Interview with the administrator confirmed that the resident's MOR was not up- to-date, the vital signs were not documented 2 times a week, and the resident was not weighed 2 times a week. 24. The above actions or inactions are a violation of Rule 58A-5.0185(5) (b), Florida Administrative Code (2002), which requires the facility to maintain a daily up-to-date, medication observation record 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. 25. 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) (c), Florida Statutes (2002), the Agency is authorized to impose a fine in the amount of seven hundred and fifty dollars ($750). COUNT II RESPONDENT FAILED TO ENSURE THAT ANY CHANGE IN DIRECTIONS FOR USE OF A MEDICATION FOR WHICH THE FACILITY IS PROVIDING ASSISTANCE WITH SELF-ADMINISTRATION OR ADMINISTERING MEDICATION IS ACCOMPANIED BY A WRITTEN MEDICATION ORDER ISSUED AND SIGNED BY THE RESIDENT’S HEALTH CARE PROVIDER, OR A FAXED COPY OF SUCH ORDER. Fla. Admin. Code R.58A-5.0185(7) (d) (2002) REPEAT CLASS III DEFICIENCY 26. The Agency re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 27. On or about November 27, 2002, a complaint survey was conducted at Respondent's facility. 28. Based on a review of six residents’ medications, Medication Observation Records (MOR), resident records, and resident/staff interview, Respondent failed to record residents’ (Residents #1, #2, #3, #4, #5 and #6) written medication orders in the MOR when their medication directions were changed. Findings: 1. A review of Resident #1's medications and MOR showed he is taking Benadryl 50 mg., three times a day and Risperdal 3 mg. every night. A review of the tesident's medical record showed the health assessment dated 6/21/01 has Risperdal 3 mg., two tablets twice a day, and Benadryl 50 mg. twice a day. There were no other doctor's orders in the resident's medical record. Interview with Resident #1 revealed that he took both of these medications at the time indicated on the MOR. 2. A review of Resident #2's medications and MOR showed she is taking Geodon 80 mg., twice a day. However, a review of the health assessment dated 1/31/02 showed the doctor ordered Geodon 60 mg., twice a day. There were no other doctor's orders in the resident's medical record. 3. A review of Resident #3's medications and MOR showed she is taking Klor- Con 10 mg., twice a day. A review of the health assessment on 8/30/00 showed she is to take the medication once a day. Further review of the medical record tevealed there were no other doctor's orders. 4. A review of Resident #4's medications and MOR showed he is taking Hydrochlorothiazide 25 mg,. once a day, Accupril 40 mg.,once a day, Klor-Con once a day, Neurontin every 12 hours, Zoloft every night and Risperdal every night. A review of the resident's medical record showed a health assessment completed on 7/15/01 showing the doctor ordered Risperdal once in the morning and once at night. Further review of the resident's medical records revealed there were no other doctor's orders. Interview with Resident #4 was revealed that he takes four pills in the morning and three pills at night, which is what is documented on the MOR. 5. A review of Resident #5's medications and MOR showed that she is to take Neurontin 400 mg., 1 tablet in the morning, 2 tablets at lunch and 2 tablets at night, Prozac 20 mg. once a day and Klonopin .5 mg. three times a day. A review of the resident's medical records showed a health assessment, completed on 2/8/02, which shows she is to take Klonopin | mg. twice a day, Prozac 40 mg. in the morning, Neurontin 300 m g. in the morning and 600 mg. at night and Risperdal 1 mg., twice a day. Further review of the resident's medical records revealed there were no other doctor's orders. Interview with Resident #5 revealed that she takes all of her medications. These medications are shown on the MOR as indicated by the resident. 6. A review of Resident #6's medications and MOR shows he is taking Clonidine 2 mg. every day and Risperdal 2 mg. every night. A review of the resident's medical record revealed a health assessment, dated 4/20/01, in which the doctor ordered Rocaltrol 25 mg., two in the morning and two at night, Synthroid 75 mg. in the morning, Topamax 50 mg. in the morning and at night, Geodon 60 mg. in the morning and at night, and Tums, two tablets at 8:00 A.M., 12 noon, 4:00 P.M. and 9:00 P.M. There were no other medication orders in the resident's medical records. Interview with staff stated he had never received a written order from the doctor when the medications were changed. 29. Respondent was provided a mandated correction date of December 27, 2002. 30. On January 30, 2003, the Agency conducted a complaint follow-up survey. The deficiencies cited at the November 27, 2002 survey had been corrected at that time. 31. On June 16, 2003, a Biennial survey visit was conducted at Respondent’s facility. 32. Based on medication review and staff interview, Respondent failed to ensure that, when a resident’s medication has been changed by the resident’s health care provider, the medication label is not altered and medication labels indicate the number of tablets to be given and how many times a day for two of three (#2 & #4) sampled residents. Findings: 1. Review of resident #2's medications revealed Clonazepam, Img, | tab tid (three times a day). Further review revealed the medication label to be changed in ink to read 1/2 tab, bid (twice a day). There was no documentation of an alert label placed on the medication bottle to alert other staff of the change in the medication dosage and time. 2. Review of resident #4's medications revealed the medication Prozac, 20mg. There was no documentation of how many tabs were to be given and how many times the medication was to be given, nor was an alert label placed on the medication bottle. 3. Interview with the administrator revealed that their pharmacy will not issue a new label when the health care provider changes medications and alert labels were not placed on the medication bottles. 33. The above actions or inactions are a violation of Rule 58A~5.0185(7) (d), Florida Administrative Code (2002), which requires that 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 a written medication order issued and signed by the resident’s health care provider, or a faxed copy of such order. New directions for use of a medication must promptly be recorded in the resident’s medication observation record. 34. 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) (c), ll Florida Statutes (2002), the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). COUNT III RESPONDENT FAILED TO ENSURE THAT ALL REGULAR AND THERAPEUTIC MENUS TO BE USED BY THE FACILITY ARE REVIEWED ANNUALLY BY A REGISTERED DIETITIAN, LICENSED DIETITIAN/NUTRITIONIST, OR BY A DIETETIC TECHNICIAN SUPERVISED BY A REGISTERED DIETITIAN OR LICENSED DIETITITAN/NUTRITIONIST TO ENSURE THE MEALS ARE COMMENSURATE WITH THE NUTRITIONAL STANDARDS. Fla. Admin. Code R.58A-5.020(2) (c) (2002) REPEAT CLASS III DEFICIENCY 35. The Agency re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 36. On or about May 17, 2001, a biennial survey was conducted at Respondent’s facility. 37. Based on record review and staff interview, Respondent failed to have menus that were approved annually by a Registered or Licensed Dietitian. Findings: During tour of the facility on May 17, 2001, at 8:45 A.M., the posted menus currently in use by the facility were observed to be dated July 11, 1999. Review of the approval letter sent by the Registered Dietitian (RD) revealed that the expiration date for the menus was July 11, 2000. Interview with the Administrator at 10:05 A.M., revealed that the menus had not been approved since July, 1999 and she was currently in the process of rewriting the menus prior to approval by the RD. Review of the facility's Food Service Policy (undated) revealed, "...obtain review of menus by RD annually." 12 38. Respondent was provided a mandated correction date of June 16, 2001. 39. On or about July 11, 2001, a biennial follow-up survey was conducted at Respondent’s facility. The deficiency cited at the May 17, 2001 survey had been corrected. 40. On or about June 16, 2003, a Biennial survey was conducted at Respondent’s facility. 41. Based on facility menu review and staff interview, Respondent failed to ensure that the facility menus were reviewed and approved by a Registered Dietitian. Findings: Review of the facility's menus revealed the last documented date the menus were reviewed by the Registered Dietitian was May 24, 2002. There was no documentation that the facility's menus were reviewed and approved within 365 days of the previous review. Interview with the administrator revealed that she thought the menus were to be reviewed in July, 2003, and therefore, the menus were not reviewed and approved within the 365 days of the previous review. 42. The above actions or inactions are a violation of Rule 58A-5.020(2) (c), Florida Administrative Code (2002), which requires that all regular and therapeutic menus used by the facility shall be reviewed annually by a registered dietitian, licensed dietitian/nutritionist, or by a dietetic technician supervised by a registered dietitian or licensed dietitian/nutritionist to ensure the meals are commensurate with the nutritional standards. 13 43. 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) (c), Florida Statutes (2002), the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). COUNT IV RESPONDENT FAILED TO ENSURE THAT DESIGNATED STAFF HAVE COMPLETED LIMITED MENTAL HEALTH TRAINING. Fla. Admin. Code R.58A-5.029(3) (d) (2002) Fla. Admin. Code 58A-5.0191(8) (2002) REPEAT CLASS III DEFICIENCY 44. The Agency re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 45. On or about May 17, 2001, a biennial survey was conducted at Respondent’s facility. 46. Based on observation, record review and interview, Respondent failed to maintain documentation on file that indicated that two of three staff (Staff #1 and #2) who had direct contact with mental health residents, had completed Limited Mental Health Training. Findings: 1. Observation of Staff #1 and #2 on May 17, 2001, from 9:00 A.M. through 3:00 P.M., revealed that they had direct contact with mental health residents throughout the day when serving meals and passing medications. Review of personnel records and administrative files for Staff #1 and #2 revealed no record that they had attended an approved training related to their job duties regarding work with Limited Mental Health residents. During interview with Staff #1, at approximately 11:30 A.M., she stated that she had attended the training, but could not find the certificate. Interview with the Administrator confirmed that the staff person had attended the training, but the facility did not have the certificate on file. 47. Respondent was provided a mandated correction date of June 16, 2001. 48. On or about July 11, 2001, a biennial follow-up survey was conducted at Respondent’s facility. The deficiencies cited at the May 17, 2001 survey had been corrected. 49. On or about June 16, 2003, a Biennial survey was conducted at Respondent’s facility. 50. Based on personnel record review and staff interview, Respondent failed to maintain documentation on file that indicated that one of four staff (Staff #2), who had direct contact with mental health residents, had completed Limited Mental Health Training. Findings: 1. Review of staff #2's personnel record, who was hired April 19, 2002 and provides direct care to residents with mental disabilities, revealed that the record lacked documentation of six hours limited mental health training within six months of employment. 2. Interview with the administrator revealed that staff #2 has had the required training, but did not have the certificate on file in the staff's personnel record. 51. The above actions or inactions are a violation of Rule 58A-5.029(3) (d) and 58A-5.0191(8), Florida Administrative Code (2002), which requires that within six months of receiving a limited mental health license, or within six months of employment in a facility holding a limited mental health license, the administrator and designee, and staff in direct contact with mental health residents must complete a minimum of six hours training provided or approved by the Department of Children and Families. 52. 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)(c), Florida Statutes (2002), the Agency is authorized to impose a fine in the amount of five hundred dollars ($500). 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 Counts I, II, III and Iv; 2. Impose a fine in the amount of two thousand two hundred and fifty dollars ($2,250) for the violations cited in Counts I, II, III, and Iv against the Respondent, 16 pursuant to Section 400.419(1)(c), Florida Statutes (2002); 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 (2002). 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: Lealand McCharen, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. 4 Respectfully submitted this My YK aay of August, 2003. atrina D. Lacy, Esquire AHCA - Senior Attorney Fla. Bar No. 0277400 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 via U.S. Certified Mail Return Receipt No. 7002 2030 0007 8499 7048 to Joanne Prettyman, Owner/Administrator, New Beginnings ALF, 2885 Janet Drive, North Fort Myers, FL 33903 dated on Augustc¥@# 2003. Mitra D. “yf Katrina D. Lacy, Esquir Copies furnished to: Joanne Prettyman Owner/Administrator New Beginnings By Joanne Prettyman 2885 Janet Drive North Fort Myers, Florida 33903 (U.S. Certified Mail) Katrina D. Lacy, Esq. Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 18

Docket for Case No: 03-004510