—- of Administrative Hearings STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINI TRAT® D 5 [1A AHCA CASE NO. 2002046874 2002047645 Vv. bh 25: Lhelety 2002047460 LARGO ACLF, LTD., D/B/A 2 THE HOMESTEAD OF LARGO, ON: O74 4s Certified Article Number 7106 4575 1294 2050 3b50 Respondent. ) SENDERS RECORD AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, ADMINISTRATIVE COMPLAINT COMES NOW THE AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter referred to as AHCA), by and through its undersigned counsel, and files this Administrative Complaint against LARGO ACLF, LTD., D/B/A THE HOMESTEAD OF LARGO (hereinafter referred to as “Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2001), and alleges the following: Nature of the Action SS OF be Action 1. This is an action to impose an administrative fine upon Respondent pursuant to Section 400.419, Florida Statutes. Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. AHCA has jurisdiction over Respondent pursuant to Chapter 400 Part III, Florida Statutes. 4. Venue vests pursuant to Rule 28-106.207, Florida Administrative Code. t, Parties - . — 5. Pursuant to Chapter 400, Part III, Florida Statutes, and Rules 58A-S, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to assisted living facility laws and rules. 6. Respondent operates an assisted living facility located at 750 Starkey Road, Largo, Florida 33771. 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, with 168 beds and having been issued license number 7301. COUNT I RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO MAKE EVERY REASONABLE EFFORT TO ENSURE THAT PRESCRIPTIONS FOR RESIDENTS WHO RECEIVE ASSISTANCE WITH SELF-ADMINISTRATION OF MEDICATION, WERE RE- FILLED IN A TIMELY MANNER. Rule 58A-5.0185 Florida Administrative Code (2001); and Section 400.414 Pla.Stat. (2001) 7. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 8. On or about August 22, 2002, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not make every reasonable effort to ensure that prescriptions for residents who receive assistance with self-administration of medication, or who self administer but have centrally stored medications and depend of the facility for their supply are refilled in a timely manner for 4 of 9 residents reviewed. ~~ ~ Findings include: ~~” —_— Based on record review and an interview with the DON, on the day of the investigation 08/22/02, 4 of 9 medication reviews ( resident #1, 2,7 and #9 ) missed medication on dates to include June, July and August 2002 due to prescriptions that were not refilled in a timely manner. 1. Resident #) was out of Prempro June 1-7 and July 8-10, Ocupress eye drops June 2-8 and again in August, Nitro patch 0.4mg July 6-14 and again in August and a review of July and August MORs revealed other medications that were not available. 2. Resident #2 was missing all four of her medications from June 21-30, July 1- 15 and August 16-2. 3. Resident # 7 had 13 medication that were not available on one or more days in August to include Metformin and Synthroid as well as medication to include Synthroid and Prevacid that were not available in June and/ or July. 4. Resident # 9 was out of Micardis 60 mg for blood pressure from August 2-21. All above medication was noted as available on the day of the investigation 08/22/02 except resident # I's eye drops. 9. Based on the foregoing, Respondent has violated Rule 58A-5.0185(7) (f) Florida Administrative Code (2001), by reason of the fact that Respondent failed to make every reasonable effort to ensure that prescriptions for residents who receive assistance with their medication, were re-filled in a timely manner. 10. The foregoing violation constitutes a Class II “II” violations are those conditions or violation. Ciass occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than class I violations. A Class II violation is subject to an administrative fine in am amount not less than $1,000 and not exceeding $5,000 for each violation. A citation for a Class II violation must specify the time within which the violation is ™ — 6 . ‘ required to be cormméted. AHCA is authorrzet~co impose a fine of $5,000. 11. The facility was given a mandated correction date in accordance with Section 400.419({1) (b), Florida Statutes of August 25, 2002. 12. Section 400.419(9) authorizes assessment of a survey fee, In the context of the present facts and circumstances 4 survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount ef $5,000.00. c) Impose and assess a survey fee of $500.00 in addition to the imposed fine. d) Any other general and equitable relief as deemed appropriate. COUNT II RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO ENSURE THAT CARE AND SERVICES APPROPRIATE TO THE NEEDS OF RESIDENTS ACCEPTED FOR BDMISSION TO THE FACILITY WAS PROVIDED. Chapter 58A-5.0182 Florida Administrative Code (2001); and Section 400.414 Fla.Stat. (2001) _o_ 13. AHCA re-alweges and incorporates wy 1—erence paragraphs one (1) through six (6) above as if fully set forth herein. 14. On or about August 22, 2002, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review, observation and interview it was determined that the facility had not provided care and services appropriate to the needs of five of nine residents reviewed during the investigation. Findings include: Record review, observation and interviews with the DON and administrator during the investigative survey of 08/22/02 revealed that the facility had not provided appropriate care and services to residents in the following incidents: 1. The steps which trained staff were supposed to follow when assisting with medication were not being followed. Failure to ensure that medication assistance follows the prescribed sieps could result in an adverse effect on the medical well- being of residents, confusion as to what medications have been taken or not taken and a loss of dignity in the resident not being as involved in the self- administration of medications process as they might otherwise be able. The following discrepancies were noted: a, Observation of the medication pass for residents including # 8 and 9 revealed that centrally stored medication, in its dispensed, properly labeled containers were being opened, the dosage was being placed in another container and this was taken from the medication room to the resident for distribution. b. Residents # 1, 2 and 7 had notations in the MOR for medications given on a day or at a time when other documentation noted that no medication was available for that resident. For resident # 1 Ocupress 1% eye drops were markcd as given on the moming of the investigation 08/22/02, it had not been available for several previous days per MOR documentation and when the medication was requested for verification it was not found. c. Record review and observation determined that the medications for residents to include # 2 and 8 were being marked as dispensed as they were placed in altemate containers in central storage, not after they had been given. In the case of resident # 8 the moming medications had been poured into an aJternate container in the morning, that container had been returned to the medication cart and placed in another resident's drawer and distributed to the resident in the dining room at 11:45. d. Resident # 1 had medication which was administered in the form ofa patch which was to be placed on alternate arms each day. These patches had been documented as not available for three days, on the day of the investigation 08/22/02 the patches were found in the medication cart in a 5 drawer Paseled patches with 27 of 30 remarring._when asked about the patch staff indicated it was not in the medication cart drawer labeled for the resident. The patch was applied when brought to the attention of the Director of Nursing (DON). 2. Residents were denied prescribed medications, on dates to include June, July and August 2002, based on 4 of 9 medication reviews ( resident #1, 2, 7 and #9 ), due to the facility's failure to reorder medication in a timely manor or procure ordered medications for residents. The following discrepancies were noted: a. Resident #1 was out of Prempro June 1-7 and July 8-10, Ocupress eye drops June 2-8 and again in August, Nitro patch 0,4mg July 6-14 and again in August and a review of July and August MORs revealed other medications that were not available. pb. Resident # 2 was missing all four of her medications from June 21-30, July 1-15 and August 16-21. c. Resident # 7 had 13 medication that were not available on one or more days in August to include Metformin and Synthroid as well as medication to include Synthroid and Prevacid that were not available in June and/ or July. d. Resident #9 was out of Micardis 60 mg for blood pressure from August 2-21. 15. Based on the foregoing, Respondent has violated Chapter 58A-5.0182 Florida Administrative Code (2001), by reason of the fact that Respondent failed to ensure that care and services appropriate to the needs of residents was provided. 16. The foregoing violation constitutes a Class II violation. Class “II” violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than class I violations. BR Class II violation is subject to an administrative fine in an amount not less than $1,000 and not exceeding $5,000 for each violation. A citation for a Class II violation must specify the time within which the violation is 6 _ required to be corrected. AHCA is authorTzed-to impose a fine of $5,000. 17. The facility was given a mandated correction date in accordance with Section 400.419(1) (b), Florida Statutes of September 22, 2002. 18. Section 400.419(9) authorizes assessment of a survey fee. In the context of the present facts and circumstances a survey fee is assessable as this administrative complaint is predicated upon an original complaint survey citing a tag related to the confirmed complaint. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $5,000.00. c) Impose and assess a survey fee of $500.00 in addition to the imposed fine. d) Any other general and equitable relief as deemed appropriate. COUNT III RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO MAKE EVERY REASONABLE EFFORT TO ENSURE THAT PRESCRIPTIONS FOR RESIDENTS WHO RECEIVE ASSISTANCE WITH SELF-ADMINISTRATION OF MEDICATION, WERE RE- FILLED IN A TIMELY MANNER. Rule 58A-5.0185 Florida Administrative Code (2001); and Section 400.414 Fla.Stat. (2001) 19. AHCA re-alleges and incorporates By Yeference paragraphs one (1) through six (6) above as if fully set forth herein. 20. On or about August 22, 2002, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not make every reasonable effort to ensure that prescriptions for residents who receive assistance with self-administration of medication, or who self administer but have centrally stored medications and depend of the facility for their supply are refilled in a timely manner for 4 of 9 residents reviewed. Findings include: Based on record review and an interview with the DON, on the day of the investigation 08/22/02, 4 of 9 medication reviews ( resident #1, 2,7 and #9 ) missed medication on dates to include June, July and August 2002 due to prescriptions that were not refilled in a timely manner. 1. Resident #1 was out of Prempro June 1-7 and July 8-10, Ocupress eye drops June 2-8 and again in August, Nitro patch 0.4mg July 6-14 and again in August and a review of July and August MORs revealed other medications that were not available. 2. Resident # 2 was missing all four of her medications from June 21-30, July 1- 15 and August 16-21. 3. Resident #7 had 13 medication that were not available on one or more days in August to include Metformin and Synthroid as well as medication to include Synthroid and Prevacid that were not available in June and/ or July. 4. Resident # 9 was out of Micardis 60 mg for blood pressure from August 2-21. All above medication was noted as available on the day of the investigation 08/22/02 except resident # 1's eye drops. 21. On or about September 16, 2002, AHCA conducted its annual survey at Respondent’s facility. AHCA cited Respordent based upon the findings below: Based on record review the facility failed to make a reasonable effort to obtain two medications on one of nine sampled residents (#6). Failure to obtain the prescribed medication places the resident at risk for deterioration of health. Findings include: Based on record review of the Medication Administration Record, resident #6 did not receive her Colace or her Multivitamin for the period of 9/1/02 through 9/9/02. Uncorrected deficiency from 8/22/02 complaint investigation g +c ra 22. Based on the foregoing, Respondent has violated Rule S8A-5.0185(7) (£) Florida Administrative Code (2001), by reason of the fact that Respondent failed to make every reasonable effort to ensure that prescriptions for residents who receive assistance with their medication, were re-filled in a timely manner. 23. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (ce), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 24. The facility was given a mandated correction date in accordance with Section 400.419(1}(c), Plorida Statutes of August 25, 2002. Cc CLAIM FOR RELIEF ~ Cc WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT IV RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO MAINTAIN THE EXTERIOR AND INTERIOR WALLS, BEAMS, SCREENS, AND FLOORS IN GOOD REPAIR, AND FAILED TO ENSURE THEY WERE STRUCTURALLY SOUND. Rule 58A- 5.023 Florida Administrative Code (2001); and Section 400.414 Fla.Stat. (2001) 25. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 26. On or about July 17, 2001, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based upon a tour of the facility on the day of this complaint investigation all areas were not maintained in good repair. Areas include but are not limited to the following; 1. Room # 214 had multiple small holes in the bathroom wall and the bathroom vent was black with what appeared to be mold/mildew. 2. Room #102 had a large hole in the wall of the bathroom and the air conditioning vent near the bedroom window was black with what appeared to be mold/mildew. 3. The main shower area on the Personal Care Unit was observed to have ceiling damage over the shower, and peeling wall board. 27. On or about November 8, 2001, an investigative survey was performed at Respondent's facility- The deficiency cited in 10 paragraph 26 above, was noted to have been Corrteted at that time. 28. On or about September 16, 2002, AHCA conducted its annual survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility's physical structure, including the interior and exterior walls, floors, roof and ceilings were not ensured to be structurally sound and in good repair. Findings include: On the day of the survey 09/16/02, observation revealed that interior and exterior walls, floors, roof and ceilings were not ensured to be structurally sound and in good repair, in examples to include the following: 1, Areas of the outside walls on the south side of the building had holes in the siding and pieces of siding were missing form the wall outside the kitchen. 2. A beam for the roof of the porch on the east side of the building had water damaged or rotting wood. 3. Window screens throughout the facility to include the upstairs and the courtyard were badly worn some with holes. Some screens had been removed to place air conditioners in the windows but it could not be determined if the vents for the old under the window air conditioners had been sealed, 4. The bathroom floor in rooms to include # 220 had badly scraped or stained linoleum and the laundry floors, upstairs southwest was badly worm with tile broken and pieces missing where dirt can accumulate. 5. The ceiling in rooms to include # 232 had water stains. (Repeat deficiency from survey of 7/17/01) 29. Based on the foregoing, Respondent has violated Rule S8A-5.023(1) (b) Florida Administrative Code (2001), by reason of the fact that Respondent failed to ensure the exterior and interior walls, beams, screens, and floors were maintained and in good repair. 30. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or 11 “eer . eccurrences related to the operation and maintelance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is After the time for correction has required to be corrected. expired, and if the problem is not corrected, or if the problem was previously corrected and is subsequently cited at a later date, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 31. The facility was given a mandated correction date in accordance with Section 400.419(1) (c), Florida Statutes. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT V RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO ENSURE PEELING PAINT AND 12 TORN CARPETING WERE REPAIRED OR REPLACED. ule 58A-5.023 Florida Administrative Code (2001); and Section 400.414 Fla.Stat. (2001) 32. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 33.° On or about June 28, 2001, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based upon observation on 6/27 and 6/28/01 paint on the walls and door frames was observed to be chipped and/or peeling. In addition, on one of the walls in the personal care unit slanderous remarks had been written about a staff member. While attempts had been made to wash off the graffiti, it was still legible. 34. On or about November 8, 2001, an investigative survey was performed at Respondent’s facility. The deficiency cited in paragraph 33 above, was noted to have been corrected at that time. 35. On or about September 16, 2002, AHCA performed its annual survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not ensure that peeling paint or wallpaper, missing ceiling or floor tiles, or tom carpeting was repaired or replaced. Findings include: On the day of the survey 09/16/02, based on observation it was determined that the facility did not ensure that peeling paint or torn carpeting was repaired os replaced in areas to include: 1. Carpet needed to be replaced or deodorized in rooms or areas to include rooms # 206 and # 220 and the main floor from the elevator west to the entrances to the main, front and family dining rooms. 2. Repair and or painting was needed in rooms to include # 232 and 238. [= A_ 36. Based on the foregoing, Respondent has violated Rule 58A-5.023(1)Florida Administrative Code (2001), by reason of the fact that Respondent failed to ensure peeling paint and torn carpeting were repaired or replaced. 37. The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, or if the problem was previously corrected and is subsequently cited at a later date, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 38. The facility was given a mandated correction date in accordance with Section 400.419(1) (c), Florida Statutes. CLAIM FOR RELIEF WHEREFORE, AKCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. 14 “€ b) Impose a P¥ne in the amount of $17000%00 c) Any other general and equitable relief as deemed appropriate. COUNT VI RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO MAINTAIN BED LINENS, SHEETS, AND SPREADS FREE FROM URINE AND ODORS. Rule 58A-5.023 Florida Administrative Code (2001); and Section 400.414 Fla.Stat. (2001) 39. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 40. On or about July 17, 2001, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based upon a tour of the facility on the day of this complaint investigation the following furnishing were not maintained in clean and good condition. 1. The plastic dinner ware (glasses and plates) were observed to have chips, scrapes and cracks and therefore ao Jonger provided a easily cleanable surface. 2. Two wheelchairs observed sitting vacant in hallways were dirty with an accumulation of spills and caked debris on the seats. 3. The tile in the main shower area of the Personal Care Unit was observed to be dirty with a residue build-up. 4. Soiled linen containers were stored in the main shower area of the Personal Care Unit. One of the containers had what appeared to be soiled clothing thrown on top of one of the container covers thereby creating a potential infection control problem. 41. On or about November 8, 2001, an investigative survey was performed at Respondent’s facility. The deficiency cited in 15 - . — paragraph 40 above, was noted to have been corrected at that time. 42. On or about September 16, 2002, AHCA performed its annual survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: The facility did not ensure that all furniture and furnishings were clean, functional, free- of-odors, and in good repair. Findings include: On the day of the survey 09/16/02, based on observation it was determined that the facility did not ensure that all furniture and furnishings were clean, functional, free-of- odors, and in good repair. The sheets and spread or blanket on the bed nearest the window in the living room area of room # 220, was urine soaked with an odor of urine from 9:45 am until rechecked at 11:30 am. The mattress was not checked but did not appear to be sealed in waterproof materials, 43. Based on the foregoing, Respondent has violated Rule 58A-5.023(1) (b) Florida Administrative Code (2001), by reason of the fact that Respondent failed to maintain bed linens, sheets, and spreads free from urine and odors. 44, The foregoing violation constitutes a Class III violation. Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which citation specifies the time within which the violation is 16 required to be corrected. After the time ro heeerection has expired, and if the problem is not corrected, or if the problem was previously corrected and is subsequently cited at a later date, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 45. The facility was given a mandated correction date in accordance with Section 400.419(1)(c), Florida Statutes. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as deemed appropriate. COUNT VH RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO CORRECTLY LABEL RESIDENTS’ OVER-THE-COUNTER MEDICATION. Rule 58A-5.0185 Florida Administrative Code (2001); and Section 400.414 Fla-.Stat. (2001) 46. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 47. On or about August 22, 2002, AHCA performed a complaint investigation at Respondent’s facility. AHCA cited Respondent based upon the findings below: 17 Based on observation, interview and record revicw the facility failed % properly manage physician prescribed over the counter medications for one of nine sampled residents. Findings include: Record review, on 08/22/02 at 11:30 a.m., revealed that Resident # 7's physician prescribed Thiamine 100mg, Multivitamins and enteric coated Aspirin 81 mg to be given once a day and Oyst-Cal 500 to be given twice a day. These prescribed OTC medications were not available from August 1-21, they are marked as given 8/22/02. Interview with the Director of Nursing and the Administrator on 08/22/02 at 1:30 p.m. revealed that Medicaid did not pay for these medications and that the facility had contacted the physician who did not wish to changc his orders. 48. On or about September 16, 2002, AHCA performed its annual survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on observation, the facility failed to provide labels to over the counter medications on two of nine sampled residents (#5 ). Findings include: Based on observation on 9/16/02 at 10:00 a.m. the facility failed to provide proper labels on Cojace and Multivitamin on resident #6. Resident #5 had an order for Acetaminophen EX the drug was not properly labeled. 49. Based on the foregoing, Respondent has violated Rule 58A-5.0185 Florida Administrative Code (2001), by reason of the fact that Respondent failed to properly label residents’ over- the-counter medication. So. The foregoing violation constitutes a Class III violation. Class “III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of the facility residents, other than class I or class II violations. As a class III violation, and pursuant to Section 400.419(1) (c), Florida Statutes, AHCA may give a citation for the violation, which 18 citation specitie@ ere time within which té yeslation is required to be corrected. After the time for correction has expired, and if the problem is not corrected, or if the problem was previously corrected and is subsequently cited at a later date, a class III violation is subject to an administrative fine of not less than $500 and of not more than $1000 for each violation. AHCA is authorized to impose a fine against Respondent in the amount of $1,000. 51. The facility was given a mandated correction date in accordance with Section 400.419(1)(c), Florida Statutes of August 25, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $1,000.00 c) Any other general and equitable relief as decmed appropriate. COUNT VITI RESPONDENT DEPRIVED RESIDENTS OF THE FACILITY OF CIVIL OR LEGAL RIGHTS, OF BENEFITS OR PRIVILEGES GUARANTEED BY LAW, THE CONSTITUTION OF THE UNITED STATES AND BY THE CONSTITUTION OF THE STATE OF FLORIDA. RESPONDENT FAILED TO ENFORCE ITS POLICY WITH REGARD TO SMOKING AND FAILED TO TAKE ACTION WHEN AWARE THE SAFETY AND PHYSICAL WELL-BEING OF RESIDENTS WERE IN DANGER, RESULTING IN THE DEATH OF A RESIDENT. Rule 58A-5.018 Florida Administrative Code (2001); and Section 400.414 Fla.Stat. (2001) $2. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 19 ane $name 53. On or about September 26, 2002, ah rectornes an appraisal visit at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review and staff interviews, it was determined that the facility failed to provide daily observation and daily awareness of a resident's activities and general safety and physical well-being . The facility failed to enforce their policy regarding smoking and failed to take action when aware that the safety and physical well being of residents was in danger, resulting in the death of a resident Findings include: Interview with the Administrator and Director of Operations, on September 26, 2002 at 11:30am, revealed that a resident had died at the facility , on this date, while smoking with oxygen in use. Interview revealed that the resident was in his room and lit a cigarette while attached to an oxygen concentrator by nasal canula. The facility has a written policy regarding smoking that residents sign upon admission. Review of this resident's record revealed that the resident had signed acknowledgement of this policy upon admission on 06-08-01. The policy, dated 11-29-00, stated " Smoking is not permitted at our residence except in the courtyard. This policy is for the well being of all our residents and in compliance with the Florida Clean Air Act. Interview with two personal care attendents (PCA"s) ,at approximately 1:30 pm on 09- 26-02, revealed that they were aware that the resident had smoked in his room before. One PCA stated this information while the other PCA nodded in agreement to her statements. They stated that when they found someone smoking in their room, they would report it to the nurse or to the Administrator and stated that they had reported this resident. The Director of Operations was present during this interview and stated "well now we know" regarding whether the resident had smoked in his room before. Interview with the Director of Operations ,at 2:10pm on 09-26-02, revealed that when a resident was known to have smoked a cigarette in the building, the resident would be counseled, The Director of Operations stated that there was no documentation that this resident had been counseled regarding smoking . When asked about action taken if residents violated the rules of the facility, the Director of Operations stated " we have never issued a 45 day notice to anyone for smoking. The Director of Operations agreed that there was nothing in the resident contract which states what action the facility would take if someone violated the rules. 54. Based on the foregoing, Respondent has violated Rule S8A-5.018(2) Florida Administrative Code (2001), by reason of the fact that Respondent failed to enforce its own policy regarding smoking, and failed to take action when it was aware 20 ~, that the safety and Physical well-being of ‘Y r@Wident was in danger, resulting in the death of a resident. 55. The foregoing violation constitutes a Class I violation. Class “I” violations are those conditions or eccurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines present an imminent danger to the residents or guests of the facility or a substantial probability that death or serious physical or emotional harm would result therefrom. The condition or practice constituting a Class I violation shall be abated or eliminated within 24 hours, unless a fixed period, as determined by the agency, is required for correction. A class I violation is subject to an administrative fine in an amount not less than $5,000 and not exceeding $10,000 for each violation. A fine may be levied notwithstanding the correction of the violation. AHCA is authorized to impose a fine of $10,000. 56. The facility was given a mandated correction date in accordance with Section 400.419(1) (b), Florida Statutes of October 3, 2002. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $10,000.00. c) Any other general and equitable relief as deemed appropriate. 2] Dated: October 21, Ss AL Agency for Health Care Administration Senior Attorney Fla. Bar. No. 0174629 22 qe NOTICE =e Respondent, LARGO ACLF, LTD., D/B/A THE HOMESTEAD OF LARGO hereby is notified that Respondent has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to AHCA, Jodi C. Page, Esquire, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida, 32308. In order to preserve your right to a hearing, your Election of Rights in this matter must be received by AHCA within twenty-one {21) days from the date you receive the Administrative Complaint. If the election of rights form with your selected option is not received by AHCA within twenty-one (21) days from the date of your receipt of the Administrative Complaint, a final oxder will be issued finding the deficiencies and/or violations charged and imposing the penalty sought in the Complaint. Dated: October 21, 2002 AGENCY FOR HEALTH CARE ADMINISTRATION 58 Page, oe Senior Attorney Fla. Bar. No. 0174629 23 Cc -& CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint has been sent by Certified Mail (#7106 4575 1294 2050 3690) to The Homéstead of Largo, 750 Starkey Road, Largo, Florida 33771, this 21st day of October, 2002. AGENCY FOR HEALTH CARE ADMINISTRATION wet - Page, Bese 1 Senior Attorney Pla. Bar. No. 0174629 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 9212-0158 (fax) 24

Docket for Case No: 05-000995