STATE OF FLORIDA rr. AGENCY FOR HEALTH CARE ADMINISTRATION | 9 0 etd WV STATE OF FLORIDA diy. 8 PH 4. 13 AGENCY FOR HEALTH CARE AOM ha Jie ADMINISTRATION, HE A STRAY, AEN Ee Petitioner, vs. Case Nos. 2004008620 2004008203 ROSEMONT HEALTH CARE ASSOCIATES, LLC, a ( -l [ C 5 | d/b/a ROSEWOOD HEALTH AND REHABILITATION CENTER, 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 ROSEMONT HEALTH CARE ASSOCIATES, LLC, d/b/a ROSEWOOD HEALTH AND REHABILITATION CENTER, (hereinafter Respondent), pursuant to §§ 120.569, and 120.57, Fla. Stat., (2003), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of $1.000.00 and assign a conditional licensure status commencing August 10, 2004, based upon one uncorrected cited State Class Ill deficiency for Respondent failing to ensure that a new medication ordered for a resident was delivered in a timely manner. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Fla. Stat. (2003). 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of nursing homes and enforcement of applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended); Chapter 400, Part II, Florida Statutes, and; Fla. Admin. Code R. 59A-4, respectively. 4. Respondent operates a 120-bed nursing home located at 3950 Rosewood Way, Orlando, Florida, 32808, and is licensed as a skilled nursing facility, license number 14810962. 5. Respondent 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 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. That pursuant to 42 CFR § 483.60, the Respondent must provide routine and emergency drugs and biologicals to its residents... 8. That on, or about, June 27 through 30, 2004, the Agency conducted an off hour recertification survey of Respondent. 9. That based on observation, record review and interview, the respondent facility failed to obtain medications for one of twenty three sampled residents and one random sampled resident. 10. That Petitioner’s representatives reviewed the records of resident number fourteen. 11. That resident number fourteen’s record reflects the presence of an infection of the resident for which the resident's physician ordered clindamycin 300 milligrams (mg.) and cipro 250 mg on June 26, 2004. 12. That there was no annotation or other evidence that the resident was administered the prescribed medications for a period of two days following the physician’s order. 13. That Petitioner’s representative interviewed nursing staff on June 28, 2004, who indicated that resident fourteen’s prescribed medication referenced above was first delivered on June 28, 2004. 14. That during medication pass observation by Petitioner’s representatives on the morning of June 28, 2004, it was noted that resident number twenty-four was scheduled to receive buspar 5 mg. and effexor XR 75 mg. 15. That Petitioner’s representative interviewed nursing staff who indicated that the medication was not available. 16. That a review of resident twenty-four’s record indicated that on June 26, 2004, at 2:00 p.m., the resident's nurse practitioner wrote new medication orders, changing the dosage of the medication the resident had been taking. The new orders were for remeron 15 mg. at hour of sleep, decrease the effexor XR to 75 mg. every day and decrease the buspar to 5 mg. twice a day. 17. That the resident’s record noted in a progress note that on June 26, 2004 the nurse documented the new orders and that the order had been sent to the pharmacy. 18. That on June 28, 2004, at 9:28 a.m., neither the nurse under observation during the medication pass nor the director of nursing could locate a facsimile for the change to prescribed medications or a confirmation that such a facsimile had been sent. 19. That the nurse indicated that she had faxed the order again on June 27, 2004, however the original order sheet and confirmation maintained in records revealed that only the buspar had been ordered with no annotations as to the other medications. 20. That Petitioner’s representative interviewed the Respondent’s pharmacy consultant on June 28, 2004 at 11:20 a.m., who explained that the pharmacy was open 24 hours a day, 7 days a week. While he indicated that the pharmacy does not make Sunday deliveries unless the medication was considered necessary and important, he confirmed tat the medication ordered for resident twenty-four would be considered necessary and important and would be delivered. 21. That the facility uses the pharmacy's policy and procedure manual to direct staff in the process of ordering medications. Petitioner’s review of the manual revealed its direction to staff that, if a new medication is ordered prior to the next scheduled delivery, staff are to call the order into the pharmacy and inform the pharmacy of the need for prompt delivery and request the delivery within a reasonable amount of time (Section III, page 3.4 of the manual). 22. That the Respondent facility failed to follow its policy and procedure in obtaining new medications for resident number twenty-four by failing to call the new medication and dosages into the pharmacy rather than send a facsimile order. 23. That as a result of the Respondent facility’s failure to properly order medications, resident number twenty-four was not given the 9:00 p.m. dose of remeron 15 mg. on June 26, 2004, a dose of effexor XR 75 mg. on June 27, 2004, and the 9:00 a.m. and 5:00 p.m. doses of buspar 5 mg. on the same date. Though the medication administration record indicated that on June 26, 2004, the 5:00 p.m. dose of buspar was administered, the medication had not been delivered by that time. 24. That the Agency determined that this deficient practice was related to the personal care of the residents that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for a State Class III deficiency. 25. The Agency provided Respondent with a mandatory correction date of July 22, 2004. 26. That on August 10, 2004, the Petitioner Agency conducted a follow-up visit to the recertification survey. 27. That based upon record review and interview, it was determined that the facility failed to ensure that a new medication ordered for a resident was delivered in a timely manner for one resident in a sample of fourteen. 28. That Petitioner’s representatives reviewed the records of resident number five. 29. That on August 6, 2004, the nurse practitioner for resident number five wrote a new order for Lexapro 5 mg every morning for five days then increase to 10 mg every morning. 30. That a nurse's note written on at 2:10 p.m. on August 6, 2004, indicated that the nurse transcribed and faxed the order to the pharmacy. 31. That resident five's Medication Administration Record (hereinafter MAR) indicates that on August 7, 8, and 9, 2004, resident five did not receive the medication. The reverse of the MAR annotated that the medication was not available and that the pharmacy was notified. 32. That the annotation of August 9, 2004, at 10:00 a.m. reflected that, for the first time, a nurse had called the pharmacy and was informed by the pharmacy that it had not received the order. 33. That the nurse then requested by facsimile resident five’s medication order. 34, That resident five first received the medication ordered on August 6, 2004 on the morning of August 10, 2004, four days after it should have been started. 35. That Petitioner’s representative interviewed the Respondent’s nursing administrative staff on August 10, 2004 and was informed that if a medication order is received by the pharmacy by 8:00 p.m., the medication should be delivered on the midnight delivery run by the pharmacy. If after 8:00 p.m., the medication would be delivered at 4:00 p.m. the next day. 36. That based thereon, resident five’s medication should have been delivered on August 6, 2004 with the midnight delivery. 37. That the Petitioner's representatives reviewed the Respondent facility's Physician Order Education Checklist which directs nursing staff to send by facsimile any new order to the pharmacy and place confirmation that the pharmacy received the order in an accordion file at the station. 38. That Petitioner’s representative interviewed the Respondent’s Unit Manager (UM) and the Director of Nursing (DON) on August 10, 2004. Neither could locate confirmation that resident five’s medication order was ordered and received by the pharmacy on August 6, 2004. The UM called the pharmacy and the pharmacy indicated that it did not receive the order until August 9, 2004. 39, That the Physician Order Education Checklist also directs nursing staff that should ordered medication not be delivered on the next run, staff must call the pharmacy and document on the MAR that the pharmacy was called and with whom they spoke. The procedure should be repeated until the medication is delivered with an instruction to request stat delivery beginning with the second call. 40. That the MAR reflects that, on the three days the medication was not available for resident five, the pharmacy was notified, however, it contained no annotation indicating who in the pharmacy was contacted or that stat delivery was requested. There was no documentation elsewhere in the resident's record that this was done. 41. That Petitioner’s representative interviewed the Respondent’s nursing administrative staff on August 10, 2004 and learned that in-service training on the Physician Order Education Checklist was offered on July 14 and 15, 2004. One nurse who had incorrectly or incompletely documented resident five’s MAR during the relevant period had attended this training. The other nurse, a per diem nurse, who documented incorrectly on the MAR, did not attend the in-service training. 42. That the Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for an uncorrected State Class HI deficiency. 43. That the Agency provided Respondent with a mandatory correction date of August 31, 2004. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1.000.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8)(b) and 400.102, Fla. Stat. (2003), and assess costs related to the investigation and prosecution of this case, pursuant to § 400.121(10), Fla. Stat. (2003). COUNT II 44, The Agency re-alleges and incorporates paragraphs (1) through (5) and (7) through (43) as if fully set forth herein. 45. Based upon Respondent’s one uncorrected cited State Class III deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part II of Florida Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Fla. Stat. (2003) for the perior August 10, 2004 through September 16, 2004. WHEREFORE, the Agency intends to assign a conditional licensure status to Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(7) commencing August 10, 2004 through September 16, 2004. ¥ Respectfully submitted this _/ 2 day of October, 2004. mk Walsh, Il Fla. Bar. No. 566365 Agency for Health Care Administration 525 Mirror Lake Drive, 330L St. Petersburg, FL 33701 727.552.1439 (office) 727.552.1440 (fax) 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 Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the attention of: 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail, return receipt no: 7003 1010 0002 4667 0609 on October _/3__, 2004 to Daniel H. Beeler, Administrator, Rosewood Health & Rehab., 3920 Rosewood Way, Orlando, Florida, 32808, and by U.S. Mail to CT Corporation System, Registered Agent, Rosewood Health & Rehab., 1200 South Pine Island Rd., Plantation, FL 33324.. : / if} Thoma “bs Tl Copies furnished to: Daniel H. Beeler CT Corporation System Thomas J. Walsh, II Administrator Registered Agent Senior Attorney Rosewood Health & Rehab. Rosewood Health & Rehab Agency for Health Care 3920 Rosewood Way 1200 South Pine Island Rd. Administration Orlando, FL 32808 Plantation, FL 33324 525 Mirror Lake Dr., 330G (Certified U.S. Mail) (U.S. Mail) St. Petersburg, FL 33701 (Interoffice Mail)

Docket for Case No: 04-004051