Certified Mail Receipt (7004 1160 0003 3739 8729) STATE OF FLORIDA. AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, oO Bry: Petitioner, AHCA NOS: 2005007558 Bae, a ~ F v. 2005007559 “& NORTHPORT HEALTH SERVICES OF FLORIDA, LLC d/b/a DAYTONA BEACH HEALTH AND REHABILITATION CENTER, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Northport Health Services of Florida, LLC d/b/a: Daytona Beach Health and Rehabilitation Center, (hereinafter “Daytona Beach Health and Rehabilitation Center”), pursuant to Section 120.569, and 120.57, Fla. Stat., (2005), and alleges: NATURE OF THE ACTION 1. This is an action to impose one (1) administrative fine in an amount of One Thousand Dollars ($1,000.00), against Daytona Beach Health and Rehabilitation Center for one (1) uncorrected class III deficiency, pursuant to Sections 400.23(8)(c), Fla. Stat. (2005) and Sections 59A-4.107(5), Fla. Admin. Code (2005). {URISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to 400, Part Il and Section 120.569 and 120.57, Fla. Stat., (2005). 3. Venue lies in Volusia County, Daytona Beach, Florida, pursuant to Section 120.57, Fla. Stat, (2005); and 59A4, Florida Administrative Code (2005), 28.106.207, Florida Administrative Code. (2005). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statues and tules governing nursing home facilities pursuant to Chapter 400, Part II, Florida Statutes, (2005), and Chapter 59A-4, Florida Administrative Code (2005). 5. Daytona Beach Health and Rehabilitation Center is a for-profit corporation, whose 180-bed nursing home facility is located at 1055 3" Street, Daytona Beach, Florida. Daytona Beach Health and Rehabilitation Center is licensed as a nursing home facility license #SNF11210961; certificate number 12545, effective July 01, 2005, through June 30, 2006. Daytona Beach Health and Rehabilitation Center was at all times material hereto, a licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNT 1 DAYTONA BEACH HEALTH AND REHABILITATION FAILED TO ENSURE THAT THE NURSING STAFF FOLLOWED PHYSICIAN ORDERS FOR MEDICATION ADMINISTRATION AND A CONSULT WITH A SPECIALIST FOR TWO (RESIDENTS #3 AND #14) OF FOURTEEN SAMPLED RESIDENTS. STATE TAG N054-PHYSICIAN ORDERS Section 400.23(8)(c), Fla. Stat. (2005) RULES EVALUATION, AND DEFICIENCIES; LICENSURE STATUS Section 59A-4.107(5), F.A.C. (2005) PHYSICIAN SERVICES 6. AHCA te-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about July 25, 2005, AHCA conducted a revisit visit at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a.) On or about June 23, 2005, Daytona Beach Health and Rehabilitation Center failed to ensure that the nursing staff followed physician orders for medication administration and therapeutic diets for 3 of 24 sampled residents (Resident's 5, 13, and 14). b.) During a revisit survey on or about July,25, 2005, Daytona Beach Health and Rehabilitation Center failed to ensure that the nursing staff followed physician orders for medication administration and a consult with a specialist for two (Residents #3 and #14) of fourteen sampled residents. The findings are: 1. A review of the medical record for Resident #14 revealed thar the attending physician had written an order to be notified if the resident's blood glucose level was below 70. A review of the Medication Administration Record (MAR) revealed that the resident's glucose level was 46 on 1/2/05. No documentation could be found to indicate thar the physician was notified. The attending physician also wrote an order for all glucose levels below 80 to be treated with orange juice or Glucagon and to repeat the glucose test in 30 minutes. A review of the MAR revealed that the resident's glucose level was 70 on 7/25/05. No documentation could be found that the resident was given juice or Glucagon or thar the glucose level was repeated in 30 minutes. 2. Resident # 14 is receiving a hypertensive medication. The attending physician included parameters for the administration of the medication, if the systolic blood pressure is less than 100, the medication is to be held. A review of the MAR for July revealed thar the medication was administered everyday. No documentation could be found that the resident's blood pressure was taken prior to administration to ensure that the systolic reading was greater than 100, 3, During a record review of Resident #3 on 1/15/05, a physician's order dated 7/ 19/05 was noted for the resident to be seen by the psychiatrist for a reevaluation of the increase in Risperdol as the resident appeared to have increased sedation. No documented evidence could be found the order was carried out. An interview with the unit nurse on 7/15/05 at 1:30 p.m. confirmed that although che psychiatrist was at the facility on 1/22/05, the resident had not been seen. 8. The regulatory provisions of the Fla. Stat. (2005), that are pertinent to this alleged violation tread as follows: 400.23 Rules; evaluation and deficiencies; licensure status. (c) A class Ill deficiency is a deficiency thar the agency determines will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident's ability to maintain or teach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class III deficiency is subject to a civil penalty of $1,000 for an isolated deficiency, $2,000 for a patterned deficiency, and $3,000 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class 1 or class Il deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A citation for a class Ill deficiency must specify the time within which the deficiency is required to be corrected. If a class III deficiency is corrected within the time specified, no civil penalty shall be imposed. * * * 59A-4.107 Medications Practices. ~ (5) All physician orders shall be followed as prescribed, and if not followed, the reason shall be recorded on the resident's medical record during that shift, ee 9. The violation alleged herein constitutes an uncorrected class IIL deficiency, and warrants a fine of $1,000. WHEREFORE, AHCA demands the following relief: L. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $1,000. Respectfully submitted this $ an of October 2005. Michael O. Mathis, Esquire Fla. Bar. No. 0325570 Counsel of Petitioner, Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 922-5873 (office) (850) 921-0158 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Fla. Stat. (2004). 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 the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael O. Mathis, Senior Attorney, Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL REASULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on yt day of D et aber , 2005 to Vernon Zeger, Administrator, Daytona Beach Health and Rehabilitation Center, 1055 3" Street, Daytona Beach, Florida 32117. Michael O. 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Docket for Case No: 05-004520