STATE OF FLORIDA Ack Le Dt AGENCY FOR HEALTH CARE ADMINISTRA al CPi kt 10 AGENCY FOR HEALTH CARE nih ADMINISTRATION, Petitioner, AHCA No.: 2004000723 AHCA No.: 2004000161 v. Return Receipt Requested: 7002 2410 0001 4237 0188 PINEHURST HEALTH CARE ASSOCIATES, 7002 2410 0001 4237 0195 LLC, d/b/a SEAVIEW NURSING AND 7002 2410 0001 4237 0201 REHABILITATION CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter referred to as “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Pinehurst Health Care Associates, LLC, d/b/a Seaview Nursing and Rehabilitation Center “Seaview Nursing and Rehabilitation Center”), pursuant to Chapter 400, Part II, and Section 120.60, Fla. Stat. (2002), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $1,000.00 pursuant to Section 400.23(8), Fla. Stat. (2002), for the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Seaview Nursing and Rehabilitation Center, pursuant to Section 400.23(7)(c), Fla. Stat (2002). JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2002), and Chapter 28-106, F.A.C. 4. Venue lies in Broward County, pursuant to Section 400.121(1) (e), Fla. Stat. (2002), and Rule 28-106.207, Florida Administrative Code. PARTIES 5. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, Part II, Fla. Stat., (2002), and Chapter 59A-4 Florida Administrative Code. 6. Seaview Nursing and Rehabilitation Center is an 83-bed skilled nursing facility located at 2401 N.E. Qn Street, Pompano Beach, Florida 33062. Seaview Nursing and Rehabilitation Center is licensed as a skilled nursing facility; license number SNF1441096 certificate number 11150, effective 12/17/2003 through 11/30/2004. Seaview Nursing and Rehabilitation Center was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with ali applicable rules and statutes. 7. Because Seaview Nursing and Rehabilitation Center participates in Title XVIII or XIX, it must follow the certification rules and regulations found in Title 42 C.F.R. 483, as incorporated by Rule 59A-4.1288, F.A.C. COUNT I SEAVIEW NURSING AND REHABILITATION CENTER FAILED TO ENSURE THAT ALL RESIDENTS WERE FREE FROM SIGNIFICANT MEDICATION ERRORS TITLE 42, SECTION 483.25(m) (2), Code of Federal Regulations, incorporated by Rule 59A-4.1288, F.A.C. (QUALITY OF CARE) UNCORRECTED CLASS III DEFICIENCY 8. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 9. During standard survey conducted 11/12-14/2003 and based on interview and record review, it was determined that the facility did not ensure that 2 of 17 sampled residents (#9 and #7) were free from significant medication errors. Resident #9 did not receive an anti-hypertensive medication for approximately four months. Resident #7 did not receive a psychoactive medication according £o physician's orders for 12 days. The medication errors noted For both residents were determined to be significant based on the frequency of error. The findings include: we (a) During the reconciliation of the Medication Administration observation at 11:00AM on 11/12/2003 on the first floor nursing unit, it was determined through record review that Resident #9 had admission diagnoses of Hypertension, Organic Brain Syndrome, Non-psychotic Brain Syndrome, Anemia, Esophageal Reflux Disease, Neurosyphilis and Hypertension. (b) Original admission orders of 12/07/2002 contained an order for "Atenolol Tabs. 25mg 1 tab. via G- tube qi2 hrs. Hold for HR <60 or SPB <100". (HR = Heart Rate, SBP=Systolic Blood Pressure) During the Medication Administration Observation at 10:00AM on 11/12/2003, it was noted that the SBP and HR were taken and recorded but the medication "Atenolol" was not administered. Atenolol is a medication to control blood pressure (c) The reconciliation clinical record review on 11/13/2003, revealed an entry in the Medication Administration Record (MAR) for July 2003, indicating "D/C'd 7/3/03 in the column for Atenolol administration. The MARs for August, September October and November were reviewed and noted not to contain the order for Atenolol. Further review of the clinical record for Resident #9 could not determine that the medication had been discontinued by the physician. (a) Interview with the first floor Unit Manager on 11/12 and 11/13 could not ascertain the reason why the medication (Atenolol) was not administered as ordered from 7/03/2003 through 11/12/2003. The Unit Manager contacted the physician by telephone on 11/12/2003 in an attempt to verify the order to discontinue Atenolol. The physician stated that he would have to review the clinical record to assure that an order to discontinue the medication was written. Subsequent to the phone call, the Unit Manager wrote a telephone order dated 11/12/2003 "Clarification order of 7/03/2003 D/C Atenolol 25mg via PEG BID qi2h. D/C B/P + Pulse Atenolol". In interview with the Unit manager on 11/12/2003 she confirmed that there was no order from the physician to discontinue the Atenolol on 7/03/2003 or anytime thereafter. Review of the November Medication Administration Record for this resident for the period from November 1st through the morning of November 13th revealed that the heart rate was over 60 each day and the systolic blood pressure was over 100 each day. (e) On 11/13/2003, an order was written by the physician to; (1) “decrease B/P and HR to once per week. (2) Atenolol 25 mg via PEG B.I.D." Interview with the Director of Nursing and the first floor Unit Manager on 11/12-13/2003 revealed that the medication Atenolol was not wn administered from 7/3/2003 to 11/12/2003. No reason for the discontinuance could be elicited. 10. The clinical record for Resident's #7, include the following in the list of diagnoses for the resident: "Affective Psychosis." A physician's note dated 10/10/2003 for "Psychiatric follow-up and for medication and behavioral management" was noted in the record. The note documents the following: ".... continue with her angry attitude and still paranoid.. no side effect noted or reported. Plan, Increase Seroquel to 100 mg twice a day and 200 mg at hour of sleep." A review of the clinical record for Resident #7 revealed a medication order dated 10/10/2003 for "Seroquel 100 mg twice a day and 200 mg at hour of sleep." Review of the Medication Administration Record for November 2003 on 11/13/2003 did not reveal documentation that the medication was administered as ordered for any day of the month. Interview with a staff nurse on 11/13/2003 at 10:42 aM, revealed that the medication increase was not carried over to the November MAR. As a result, the medication was administered only twice a day and did not have an entry for the dosage due at hour of sleep for the 12 days of November. Correction Date: 12/14/2003. 11. During the revisit conducted on 12/17/2003 and based on interview, and record review, on 12/17/2003, it was determined that the facility still did not ensure that 1 of 9 sampled residents (#2) was free of a significant medication error. Resident #2 did not receive 2 medications (an antipsychotic and antidepressant) for 17 days. This was determined to be significant based on the frequency of error. The findings include: (a) Review of the clinical record for Resident #2 revealed an admission date of 11/18/2003. Diagnoses documented for the resident included the following: Fracture of the lower limb, Diabetes Mellitus, and Dementia. (b) Reconciliation of the December 2003 Medication Administration Record (MAR) with the current medication orders for Resident #2 revealed two medications were not documented on the MAR and there was no evidence they had been administered in the month of December. A physician's order dated 11/24/2003 specified the following: Seroquel 25 mg one by mouth twice a day for Psychosis. Lexapro 10 mg one by mouth every morning for depression. No order was noted for the discontinuance of this medication. {c) A psych consult dated 11/24/2003 documents the following: "According to staff, patient is combative and responding to internal stimuli..... Diagnosis: Organic Affective Disorder with psychosis and depression." (ad) During interview on 12/18/2003 at 11:30 AM and 12:15 PM with the staff nurse assigned to the resident, he/she could not provide evidence that the medications Seroquel and Lexapro were administered as ordered. This information was brought to the attention of the Administrator, Director of Nursing, and Corporate Nurse Consultant, who after a review of the record could not provide evidence to substantiate the medications were administered as ordered prior to the end of the survey. This is an uncorrected deficiency for the 11/12-14/2003 survey. 12. Based on the foregoing, Seaview Nursing and Rehabilitation Center violated Title 42, Section 483.25(m) (2) Code of Federal Regulations as incorporated by Rule 59A-4.1288, herein classified as an uncorrected Class III deficiency pursuant to Section 400.23(8)(c), Fla. Stat., which carries, in this case, an assessed fine of $1,000.00 This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). DISPLAY OF LICENSE Pursuant to Section 400.23(7)(e), Florida Statutes, Seaview Nursing and Rehabilitation Center shall post the license in a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to the facility. The Conditional License is attached hereto as Exhibit wan CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I B. Assess an administrative fine of $1,000.00 against Seaview Nursing and Rehabilitation Center on Count Tr. Cc. Assess and assign a conditional license status to Seaview Nursing and Rehabilitation Center in accordance with Section 400.23(7) (b), Florida Statutes. D. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida 32308, attention Lealand McCharen, Agency Clerk. Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. Margargt Jfljz Lig Assistant neral Counsel Agency for Health Care Administration Spokane Building, Suite 103 8350 N.W. 52°? Terrace Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drove, Suite 100 West Palm Beach, Florida 33407 (U.S. Mail) 10 Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) Skilled Nursing Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) 11 EXHIBIT “A” Conditional License License No. SNF1441096 Certificate No. Effective date: 12/17/2003 Expiration date: 11/30/2004 12 11150 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished U.S. Certified Mail, Return Receipt Requested to Everton M. Spencer, Sr., Administrator, Seaview Nursing and Rehabilitation Center, 2401 N.E. 2-4 Street, Pompano Beach, Florida 33062; Pinehurst Health Care Associates, LLC, 10210 Highland Manor Drive, Suite 410, Tampa, Florida 3361; and to C.T. Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324, on Fxb& Qb. , 2004, -. LIGENSE #: SNF1441096 Of APR -8 PHU: 16 State of Florida ,;;, AGENCY FOR HEALTH CARE ADMINISTRATION DIVISION OF HEALTH QUALITY ASSURANCE SKILLED NURSING FACILITY CONDITIONAL CERTIFICATE #: 11150 This is to confirm that PINEHURST HEALTH CARE ASSOCIATES, LLC has complied with the rules and regulations adopted by the State of Florida, Agency For Health Care Administration, authorized in Chapter 400, Part II, Florida Statutes, and as the licensee is authorized to operate the following: SEAVIEW NURSING AND REHABILITATION CENTER 2401 N.E. 2ND STREET POMPANO BEACH, FL 33062 TOTAL: 83 BEDS ISSUED ACTION EFFECTIVE DATE: 12/17/2003 LICENSE EXPIRATION DATE: 11/30/2004

Docket for Case No: 04-001192