STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2005002714 THE PLACE AT MAITLAND, INC., d/b/a PLACE AT MAITLAND (THE), 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 THE PLACE AT MAITLAND, INC., d/b/a PLACE AT MAITLAND (THE) (hereinafter Respondent), pursuant to Section 120.569, and 120.57, Florida Statutes, (2004), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of $3,500.00 (includes survey fee of $500.00) based upon one cited State Class II deficiency ($3,000.00 fine) pursuant to §400.419(2)(b) Fla. Stat. (2004). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 20.42, 120.60 and 400.407, Fla. Stat. (2004). 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable federal regulations, state statutes and rules governing “SIRNAS pesmi assisted living facilities pursuant to the Chapter 400, Part III, Florida Statutes, and Chapter 58A- 5 Fla. Admin. Code, respectively. 4. Respondent operates a 116-bed assisted living facility located at 740 N. Wymore Road, Maitland, Florida 32751, and is licensed as an assisted living facility, license number 9415. 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 Florida law, an ECC program shall provide assistance with self- administered medications, or the administrations and treatments pursuant to a health care provider's order if required by the resident’s service plan. {f the individual needs assistance with self-administration the facility must inform the resident of the qualifications of staff who will be providing this assistance, and if unlicensed staff will be providing such assistance, obtain the resident’s or the resident’s surrogate, guardian, or attorney-in-fact’s informed consent to provide such assistance as required under 400.4256, F.S. Fla. Admin. Code R. 58A-5.030(8)(b)(5). 8. That on January 28, 2005, the Agency conducted a complaint investigation of the Respondent facility. 9. That based upon the review of records and interview, the facility failed to ensure that staff licensed to administer medications (Licensed Practical Nurses) provided the service safely, effectively, and efficiently in accordance with the prevailing standards of practice in the nursing community and failed to ensure that laboratory testing was conducted as part of the administration of Coumadin as ordered by the health care provider for one of four residents who received ECC services. 10. That the Petitioner’s representative reviewed the Respondent’s records relating to resident number nine on January 19, 2005. 11. That the records of resident number nine reflected the following: a. That the resident’s health assessment, form 1823, dated November 26, 2003, reflected diagnoses of left lower leg DVT (deep vein thrombosis), history of left hip fracture and congestive heart failure, b. That the resident was prescribed Coumadin Therapy (an anticoagulant) as treatment for the DVT and on ECC for the application and removal of TED hose. 12. That the Petitioner’s representative’s review of the resident’s laboratory blood work pertaining to the Coumadin levels (PT/INR) revealed that said tests were not always performed in accordance with the healthcare provider's orders. 13. A review of the laboratory blood work orders and when the same was conducted and not conducted is summarized as follows: a. November 2003: i. Order dated- November 10, 2003 2:15 PM Hold Coumadin for 2 days then decrease dosage to | mg daily. Recheck PT/INR in 7 days, which would require checking on November 18, 2003, after starting 1 mg dose. ii. That a lab result reflects that the test was conducted on 11/19/03. iii. Order dated- November 14, 2003 bi-weekly PT/INR (Prothrombin-blood clotting time) on Wednesday. b. December 2003: iv) Se LRA EE NE iii. In accord with the order of November 14, 2003, lab tests were due to be conducted every other week on Wednesday. _ Lab tests were due on December 3, 17, and 31, 2003. The available lab results were dated December 3, 10, and 11, 2003. c. January 2004: i. lil. vi. In accord with the order of November 14, 2003, lab tests were due to be conducted every other week on Wednesday. . Lab tests were due on January 14 and 28, 2004. That a physician’s order dated January 7, 2004 required that the PT be conducted on January 7, 2004 and on January 19, 2004, and then bi- monthly thereafter. That the lab test was conducted on January 7, 2004. That a physician’s order dated January 20, 2004 directed that Coumadin be held for three days, January 20, 21, and 22, and then give Coumadin 3 mg., check PT in five days, after beginning the 3 mg. dose. That PT testing was conducted in accord with physician’s orders in January. d. February 2004: i. il. That a physician’s order dated January 7, 2004 required that the PT be conducted bi-monthly. Lab tests were due on February 11 and 25, 2004. AA TR et 99 EE iii. That an order dated February 25, 2004 required monthly PT lab tests anda Central Florida Internist progress note of the same date required a PT/INR test bi-monthly. iv. That no PT/INR lab results were located for the month of February 2004. e. March 2004 i. That previous orders required lab tests bi-monthly. ii. That an order dated March 12, 2004, required PT/INR lab tests bi-monthly iii, That no lab test results were located for the weeks of March 12" and 26", 2004. iv. That one PT/INR lab result was located for the month of March dated March 22, 2004. f. April 2004 i. That a facility note dated April 6, 2004 documented that redness was noted under the resident’s left eye and cheek and that the ARNP (Advanced Registered Nurse Practitioner) was notified. ii. That a Central Florida Internist progress note order dated April 7, 2004 read "...check PT/INR, observe bruise under eye if worsens, check PT r/o (rule out) bleed. Per note the resident's chief complaint was purple color under left eye - etiology unknown ". Also noted was an order dated "4/7/04 check PT/INR call me with results”. iii, That a Central Florida Internist progress note order dated April 14, 2004 provided "...order for PT/INR written 4/7/04 -lab conducted 4/13/04, results called 4/14/04, toxic level 5.8, Vit K 10 mg given, restart Coumadin 2 mg daily on 4/16/4. PT/INR tomorrow 4/15/04." iv. That the PT/INR was conducted on April 15, 2004 as ordered. y. That an order dated April 16, 2004 required that a PT/INR be conducted on April 23, 2004. vi. That a PT/INR result reflects that the test was conducted on April 22, 2004, one day prior to the date directed. vii. That a facility note dated April 14, 2004 AT 7:45 am reflected that the ARNP called and ordered “...Vit K stat (immediately) 1 dose 10 mg sq (subcutaneous) to be given -faxed order to pharmacy”. viii. That a note dated April 14, 2004 at 10:40 AM provided "Vit K 10 mg given at 10:40 AM, pressure applied to injection site LUA (left upper arm) covered with Band-Aid”. ix. That the facility delayed the injection of Vitamin K for 2 hours and 55 minutes. g. May 2004 i. That PT/INR lab work was done as ordered as reflected in lab results. h. June 2004 i. That an order dated June 2, 2004 required a PT/INR test. ii. That a lab result dated June 4, 2004 was located. iii. That an order dated June 9, 2004 required bi-monthly PT-INR tests. iv. That an order dated June 22, 2004 directed Vit K 10 mg sq stat. A ae A = vy. That a Central Florida Internist progress note order dated June 23. 2004 read" toxic Coumadin level, Vit K 10 mg given, check PT/INR Friday” vi. That the Friday, June 25, 2004, test was conducted as ordered. i. July 2004 i. That the order of June 9, 2004 continued for bi-monthly PT/INR tests. ii, That only one lab result was located for the month of July, July 6, 2004. j. August 2004 i. That the order of June 9, 2004 continued for bi-monthly PT/INR tests. ii. That a lab result dated August 2, 2004 was located. iii, That the test was twenty-six days since the last located result, far in excess of the bi--monthly order. iv. That the next lab result was dated August 20, 2004, more than two weeks since the prior test. k. September 2004 i. That the order of June 9, 2004 continued for bi-monthly PT/INR tests. ii. That only one lab result was available for the month of September 2004, dated September 9, 2004. 1. October 2004 j. That a lab result was located dated October 1, 2004. ii. That an order dated October 13, 2004, required bi-monthly PT/INR tests. iii. That an order dated October 21, 2004 directed hold Coumadin x 2 days then resume, check PT/INR on October 25, 2004. iv. That the lab work was collected on October 26, 2004. m. November 2004 i. That the order dated October 13, 2004, required bi-monthly PT/INR tests. ii. That only one lab result was located for the month of November, dated November 19, 2004. n. December 2004 i. That the order dated October 13, 2004, required bi-monthly PT/INR tests. ii. That an order dated December 1, 2004 required a PT/INR in the AM. iii. That a lab test was conducted on December 2, 2004. iv. That the resident was admitted to the hospital on December 8, 2004 for coumadin therapy. 14. That the above reflects the Respondent facility’s failure to provide ordered testing of the resident’s blood levels on numerous occasions with the required testing having been conducted only in three of the thirteen reviewed months. 15. That the failure to test blood levels in accord with orders directly threatened the resident’s health and resulted in curative medication administration as a result of the blood levels reaching toxic levels. 16. That the resident was discharged from the facility on December 30, 2004 in care of the legal guardian. 17. That the Agency determined that this deficient practice was related to the personal care of the resident that directly threatened the health, safety, or security of the resident and cited Respondent for a State Class I deficiency. 18 The Agency provided Respondent with a mandatory correction date of January 20, 2005. OA YE = WHEREFORE, the Agency intends to impose an administrative fine in the amount of $3,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 400.419(2)(b), Fla. Stat. (2004). COUNT II 19. The Agency re-alleges and incorporates paragraphs (1) through (5) and (7) through (18) as if fully set forth herein. 20. That as a result of the Agency’s complaint investigation ending January 28, 2005, the Respondent was cited for one Class II deficiency which arose from the subject of the complaint. 21. That pursuant to Section 400.41 9(10), Florida Statutes (2004), AHCA is authorized to, in addition to any administrative fines, assess a survey fee equal to the lesser of one-half of the facility's biennial license and bed fee, or $500, to cover the cost of conducting the initial complaint investigations that result in the finding of a violation that was the subject of the complaint, or for monitoring visits conducted under 400.428(3)(c), Florida Statutes (2004), to verify the correction of the violations. In this case, AHCA is authorized to request a survey fee in the amount of $500.00. WHEREFORE, the Agency intends to impose an additional survey fee of $500.00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 400.419(10), Fla. Stat. i Respectfully submitted this JV day of May, 2005. ] Thomas J. Walsh, If Fla. Bar. No. 566365 Counsel for Petitioner Agency for Health Care Administration $25 Mirror Lake Drive, 330G St. Petersburg, FL 3370] 727.552.1525 (office) 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 Agency for Health Care Administration, and delivered to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308; Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST 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. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing has been served by US. Certified Mail, Return Receipt No. 7003 1010 0002 4667-0807 on May ip 2005 to Donna Holshouser Stinson, Esq., BROAD and CASSEL, 215 S. Monroe St. #400, Tallahassee, Florida 32301. ‘/ / Thonyas/J. Walsh, II Senior Attorney Copies furnished to: Donna Holshouser Stinson, Esq. Thomas J. Walsh, II BROAD and CASSEL Agency for Health Care Admin. 215 S. Monroe St. #400 525 Mirror Lake Drive, 330G Tallahassee, FL 32301 St. Petersburg, Florida 33701 (U.S. Certified Mail) (Interoffice)

Docket for Case No: 05-002327

Orders for Case No: 05-002327