Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: SENIOR LIVING/LAKE MARY, LLC, D/B/A THE GABLES OF LAKE MARY
Judges: DANIEL MANRY
Agency: Agency for Health Care Administration
Locations: Sanford, Florida
Filed: Mar. 03, 2006
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Friday, June 9, 2006.
Latest Update: Dec. 23, 2024
STATE OF FLORIDA O6 MAR ~3 Pp}
AGENCY FOR HEALTH CARE ADMINISTRATION a
STATE OF FLORIDA,
AGENCY FOR HEALTH CARE
ADMINISTRATION, AHCA No.: 2005008010
2005008842
Petitioner,
V.
SENIOR LIVING/LAKE MARY, LLC,
d/b/a GABLES OF LAKE MARY, THE, O (g . QO 1 G y
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 SENIOR LIVING LAKE MARY, LLC, d/b/a THE GABLES OF LAKE MARY
(hereinafter Respondent), pursuant to Section 120.569, and 120.5 7, Fla. Stat., (2005), and
alleges:
NATURE OF THE ACTION
This is an action to impose an administrative fine in the amount of $20,000.00 based
upon Respondent being cited with two State Class I deficiencies pursuant to §400.419(2)(a) Fla.
Stat. (2005).
JURISDICTION AND VENUE
l. The Agency has jurisdiction pursuant to §§ 20.42, 120.60 and 400.407, Fla. Stat. (2005).
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
assisted living facilities pursuant to the Chapter 400, Part II, Florida Statutes, and; Chapter 58A-
5 Fla. Admin. Code, respectively.
4. Respondent operates al02-bed assisted living facility located at 3655 W. Lake Mary
Blvd., Lake Mary, Florida 32746, and is licensed as an assisted living facility, icense number
10007.
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, no resident of a facility shall be deprived of any civil or
legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or
the Constitution of the United States as a resident of a facility. Every resident ofa facility shall
have the right to, inter alia, live in a safe and decent living environment, free from abuse and
neglect, and to be treated with consideration and respect and with due recognition of personal
dignity, individuality, and the need for privacy. Section 400.428(1), Fla. Stat. (2005).
8. That on June 14-17, 2005, the Agency conducted a Complaint Survey of the Respondent.
9. That based upon observation, interview, and the review of records, the Respondent
facility failed to ensure that one sampled resident was protected from medical neglect and
tN
physical abuse and that the privacy rights of all residents in the facility receiving care and
services from nursing staff were respected and protected.
10. That resident number three resided on the Respondent’s Alzheimer's locked unit and had
been diagnosed with Alzheimer's disease.
11.‘ That the Petitioner’s representative interviewed Respondent’s staff member number three
on June 17, 2005 who communicated the following:
a.
b.
That the staff member was a direct caregiver for resident three;
That the staff member reported that resident number three often complained of
pain in the side;
That the staff member had noticed that the resident was losing weight and was not
eating;
That the staff member noticed the body of resident number three was limp on the
evening of June 8, 2005;
That the staff member, in the presence of another caregiver, reported the resident’s
condition to a nurse of Respondent;
That the Respondent’s nurse informed the staff member that the resident was just
impacted;
That the staff member had reviewed the June 2005 bowel monitoring sheet for
resident number three;
That the resident’s bowel monitoring sheet was annotated in its entirety with zeros
indicating that the resident had had no bowel movements in the month of June;
That the staff member felt that resident number three should be sent to the
hospital;
j. That the staff member was told by nursing staff that the family had to make that
decision;
k. That the staff member felt that should the staff member call 91 1, he/she would be
"chewed out".
12, That the Petitioner’s representative interviewed Respondent’s staff member number nine
on June 16, 2005 who communicated the following:
a. That the staff member had often heard resident number three complain of
constipation and yelling “Help me! Help me!”
b. That the staff member had observed resident number three as always wanting to
go to the bathroom.
13. That the Petitioner’s representative interviewed Respondent's staff member number ten
on June 17, 2005 who communicated the following:
a. That resident number three was found by staff member number six on the evening
of June 9, 2005;
b. That staff member number six contacted staff member number ten;
c. That the resident was observed with shallow breathing and brown emesis
discharging from both the mouth and nose;
d. That neither staff member attempted to do cardio-pulmonary resuscitation due to
the fact that the resident had a charted Do Not Resuscitate (DNR) order;
e. That staff member ten had told the Respondent’s nurse about the fact that the
resident was constipated but the nurses would just say, "I know, I know";
f That the resident later expired on June 9, 2005.
14. That the Petitioner’s representative interviewed a local law enforcement officer on June
15, 2005 who communicated that four of Respondent’s staff had been interviewed by law
enforcement regarding an allegation that resident number three had been hit with a pillow in the
upper body by respondent’s staff member number one, who had been suspended by the
Respondent facility for three days following the incident.
15. That the Petitioner’s representative reviewed the Respondent’s records regarding staff
member number one on June 15, 2005.
16. That staff member number one’s personnel records contained no indicia of an incident in
which the staff member struck resident number three with a pillow.
17. That the Petitioner’s representative interviewed Respondent’s administrator on June 15,
2005 who communicated the following:
a. That the administrator was aware of resident number three having been stricken
with a pillow by staff member number one;
b. That a different employee had reported that staff member number one was taking
resident number three back to the resident’s room after a meal when the resident
began crying out in a loud tone of voice;
c. That the employee stated that resident number three was struck in the upper part
of the body with a pillow by staff member number one in an attempt to quiet the
resident;
d. That staff member number one was suspended from work for three (3) days as a
result of the incident;
e. That the Respondent’s Director of Nursing (DON) was made aware of the
incident;
f That staff member one denied the incident had occurred when confronted by the
administrator;
g. That the staff member who witnessed the incident decided not to report the
incident to the abuse hotline;
h. That the administrator and the DON also decided not to report the incident to the
abuse hotline.
18. That the administrator could produce no documentation to reflect that the facility had
investigated the incident.
19, That the administrator would not give the name of the staff member making the allegation
of and witnessing the pillow incident.
20. That staff member one continued to be employed at the facility, and was observed
working on the Alzheimer's unit throughout the two (2) days of the survey.
21. That the Petitioner’s representative interviewed Respondent’s staff member number nine
on June 16, 2005 who communicated the following:
a, That the staff frequently put resident number three in his/her room alone and
closed the door when the resident was agitated and yelling out;
“b. That "...things had changed since the present DON was hired;"
c. That the DON was indifferent to residents;
d. That in one case, a resident was observed to cry because the DON repeatedly
refused to change the resident's dressing and kept putting the resident off until the
resident became so frustrated he/she began to cry;
e. That another resident had very frail skin;
f That Respondent’s certified nursing assistant (CNA) assigned to care for the
resident did not take care in transferring the resident out of bed;
g. That the CNA pulled the resident out of bed by the arms, causing skin tears to the
forearms of the resident.
22. That the Petitioner’s representative observed the second floor nurses’ station at 12:45 PM
on June 15, 2005 and noted the following:
a. That the nurse practitioner was on duty with another facility staff person;
b. That a resident seated in a wheelchair was observed receiving treatment to the
lower body area at this time;
c. That a small baby identified as belonging to the nurse practitioner was observed in
the exam room behind the nurses' station;
d. That the nurses' station was observed to be located across from an elevator from
which people were observed to be entering and exiting.
23. That the Petitioner’s representative confidentially interviewed a resident on June 15, 2005
who communicated the following:
a. That the resident believed resident privacy rights were not being protected;
b. That when the nurse practitioner visited the facility once a week, the nurse
practitioner would not visit individual residents' rooms;
c. That residents had to go to the nurses' station for treatment as the nurse
practitioner had a baby and did not want to leave the nurses’ station;
d. That the private health issues had to be discussed at the nurses’ station within
earshot of other residents and staff members;
e. That the resident’s private health concerns were being discussed openly and these
health concems provided sources of gossip for staff members and residents.
24. That the above reflects that the Respondent facility failed to ensure that the residents of
the facility were free from medical neglect and abuse and that the resident’s privacy rights were
not protected in the facility’s allowance of treatment and health consultations to take place in an
open hallway.
25. That the Agency determined that this violation constitutes the grounds for the imposition
of a Class I deficiency in that it presents 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. Pursuant to Section 400.419(2)(a), Florida Statutes (2004).
26. That the Agency provided the Respondent with a mandatory correction date of June 18,
2005.
27. That on August 24, 2005, the Agency completed a re-visit to the complaint survey of the
Respondent.
28. That based upon observation, interview and record review, the facility failed to ensure
that one (1) sampled resident in a sample of ten (10) was protected from medical neglect in the
Respondent’s failure to follow physician’s orders regarding the monitoring of blood pressure.
The resident ultimately suffered a cardio vascular accident with high blood pressure and was
admitted to a rehabilitation center for continued care and therapy in violation of law.
29. That the Petitioner’s representative reviewed the Respondent’s records regarding resident
number seven on August 22, 2005 which reflected the following:
a. That the resident’s health assessment form 1823 dated May 25, 2005 documented
the medical history as "N/A" (not applicable ) and listed the resident as
independent with ambulation, dressing, toileting, eating grooming, transferring
and needed assistance with bathing;
That the resident’s assessment included special diet instructions for a regular diet
and there were no listed medications. The form indicated "n/a" regarding
assistance or supervision of medications;
That a nurses note dated May 20, 2005 at 12:00 "resident admitted to floor,
oriented, ambulating well accompanied by relatives, blood pressure 160/79,
temperature 98.8, weight 142 Ibs";
That a physician's order dated May 25, 2005 "for blood pressures to be checked 3
times a week and to call the physician if the readings were greater than 140/90;"
‘That a nurses note dated May 25, 2005 (time not indicated) "Advanced Registered
Nurse Practitioner (ARNP) gives new orders to do blood pressures 3 times a week
noted";
That a nursing note dated August 12, 2005 at 1710 provided "patient examined at
this time per [her/his] request, blood pressure 197/102, pulse 90, speech noted to
be slurred with mild confusion noted, possible CVA/TIA, American Ambulance
picked up the resident and took them [sic] to the hospital";
That the Respondent’s resident records, including the Medication Observation
Records (MOR), contained no evidence that the orders for blood pressure checks
3 times a week were noted and acted upon or that the facility staff was even aware
of the order, with the exception of the nurse who wrote the note dated May 25,
2005;
That the Respondent’s resident records contained no indicia that the Respondent
followed through or conducted any of the ordered monitoring of the resident’s
blood pressure.
30. That the Petitioner’s representative reviewed the resident’s records maintained at the
rehabilitation center where resident was admitted on August 19, 2005 following the resident’s
hospitalization which reflected the following:
a.
That history and physical hospital admission examination dated August 12, 2005
documented resident number seven’s blood pressure as 164/93 mmHg with an
assessment of Expressive aphasia and Systolic hypertension (high blood pressure);
That the resident’s Patient Transfer and Continuity of Care (form 3008) signed
and dated by the physician on August 19, 2005 gave as the principle diagnosis "1.
CVA (Cerebrovascular Accident) with aphasia, 2. Hypertension (HTN), 3. A-
Fibs with CVR and failed swallow study." Medications and treatment orders on
the 3008 were for "nectar thick liquids & puree diet assist with meals, sit upright
to eat and drink, no straws, crush pills in apple sauce. No ice, ice cream, Jell-O or
soup, alternate liquids with solids. Boost (dietary supplement) and pudding BID
(twice daily), ASA (aspirin) 325 mg daily Catapres TS (antihypertensive) 0.1 mg
weekly Lexapro (antidepressant) 10 mg daily and PT (physical therapy) to
evaluate and treat and recommended Skilled Nursing (ECF) Duration”;
That Physicians Admission Orders, in addition to those listed in above, ordered
"Speech Therapy to do vital stimulation and ASPIRATION PRECAUTIONS;’
That the rehabilitation center Resident Admission-Data Form listed diagnoses as
CVA with aphasia, Hypertension, A- Fibs with CVR. The resident's care plan
dated August 22, 2005 documented that the resident required extensive/total assist
with bed mobility, transfer, dressing, eating, personal hygiene and bathing, was at
risk for skin breakdown and for aspiration.
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31. That the Petitioner’s representative interviewed resident number seven on August 24,
2005 who had difficulties speaking and was confused as to the events that caused the admission
to the hospital. The resident was dressed, groomed, alert, oriented to self and resting in bed.
32. That the Petitioner’s representative interviewed the Director of Nursing at the
Rehabilitation Center on August 24, 2005 who revealed that the resident was currently on
Catapress TTS 0.1 mg and the resident's blood pressures are being monitored twice a day. Said
medication regime and increased monitoring is indicated as a result of the resident’s recent
cardio vascular accident.
33. That the Petitioner’s representative interviewed the Respondent’s administrator on
August 22, 2005 who stated that the resident’s nursing note dated May 25, 2005 acknowledging
the physician’s order for blood pressure checks had been written by the Respondent’s former
director of nursing (LPN) who did not follow-up and who no longer worked at the facility. The
administrator gave no indication whether or not the administrator was aware of the order.
34. That the Petitioner’s representative interviewed the Respondent’s licensed practical nurse
regarding resident number seven on August 22, 2005 who gave no indication of an awareness of
the physician’s order for blood pressure monitoring and would offer only the fact that the nurse
was not an employee of Respondent at the time the orders were given.
35. That the Petitioner’s representative interviewed the ARNP who wrote the order for blood
pressure monitoring 3 times a week son August 23, 2005 who indicated "That when an order like
that was called to the facility it is for the facility to carry out, since the resident was not capable
of doing his/her own blood pressure.”
36. That the above reflects the respondent’s failure to ensure that its resident did not suffer
from medical neglect and as a result of said medical neglect the resident’s blood pressure was not
IH
monitored culminating in the resident’s experiencing a cardio vascular accident and subsequent
hospitalization.
37. That the agency determined that the above constitutes grounds for the imposition of a
Class J deficiency in that it presents 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.
38. That the Respondent has violated the provisions of law regarding resident’s rights by
medical neglect and privacy violations as recited herein as cited by the Agency on both its June
17 and August 24, 2005 surveys, said violations presenting present and imminent danger to the
residents.
39, That pursuant to Section 400.419(2)(a), Florida Statutes (2005), the Agency is authorized
to impose a fine in the amount of ten thousand dollars ($10,000).
40. That the Agency provided the Respondent with a mandatory correction date of August 26,
2005.
WHEREFORE, the Agency intends to impose an administrative fine in the amount of
$10,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to §
400.419(2)(a), Fla. Stat. (2005),
COUNT II
41. AHCA re-alleges and incorporates paragraphs (1) through (5) and (7) through (40) as if
fully set forth herein.
42. That pursuant to Florida law, no resident of a facility shall be deprived of any civil or
legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of F lorida, or
12
the Constitution of the United States as a resident of a facility. Every resident of a facility shall
have the right to, inter alia, live in a safe and decent living environment, free from abuse and
neglect, and to be treated with consideration and respect and with due recognition of personal
dignity, individuality, and the need for privacy. Section 400.428(1), Fla. Stat. (2005).
43. That on September 13, 2005, the Agency conducted a Revisit to the Complaint Survey of
the Respondent.
44, That based upon observation, interview, and the review of records, the Respondent
facility failed to protect three diabetic residents from medical neglect in violation of law.
45. That the Petitioner’s representative reviewed the Respondent’s records regarding
residents numbered one (1), seven (7), and eight (8) on September 13, 2005.
46. That all three residents receive assistance with medications including, but not limited to
the monitoring of blood glucose levels and the administration of insulin.
47. That the Petitioner’s representative reviewed the Respondent’s records regarding resident
number one (1) which reflected the following:
a. That the resident’s medication record for September 2005 reflected that the
resident was to receive accu-checks for blood glucose level monitoring once in the
morning and once in the afternoon with other accu-checks as needed;
b That the resident was to receive the following insulin administrations:
Novolin 70/30 100U inject 30U SubQ in the AM
Novolin 70/30 100U inject 18U SubQ in the PM;
C. That additional insulin coverage was to be administered if the resident's blood
sugar levels were in the following ranges:
Novolin R 100U Sliding Scale
0-200=0 units(u)
201-300=6 units
301-400=9 units
401-450=12 units
Call MD if greater than 450
That the resident’s physician’s order sheet (hereinafter “POS”) signed by the
advanced registered nurse practitioner (hereinafter “ARNP”) on August 10, 20005
contained a different ordered sliding scale from that written on the Resident’s
September 2005 Medication Record.
That the actual sliding scale Ordered for September 2005 was as follows:
Novolin R100 Sliding Scale was:
0-200=0 units
201-250=3 units
251-300=6 units
301-400=9 units
401-450=12 units
units greater than 12 units call MD
That a nurse’s note documented that the resident was transported and admitted to
the hospital on Angust 19, 2005 at 2100 as the resident was feeling "Chilly";
That there was no documentation available to reflect if the resident's blood sugar
was checked prior to leaving for the hospital or of what the resident was
diagnosed with upon admission to the hospital;
That the resident was readmitted to the Respondent facility on September 9, 2005;
That upon readmission, a telephone order was documented by a registered nurse
to discontinue Prilosec, continue Nexium 40mg-continue all previous medications
as ordered prior to hospitalization;
That the resident’s blood sugar was recorded at two hundred thirty-three (233) at
5PM on September 11, 2005;
k.
That in accord with the outstanding physician’s order, the resident should have
received three (3) units of Novolin R 100U;
That the records contained no indication that the resident was administered the
ordered insulin;
That on September 12, 2005, in accord with the physician’s orders of record, the
resident was to be administered 7AM dosages of insulin Novolin 70/30, inject
30U SubQ take in the AM;
That the records contained no indication that the resident was administered the
ordered insulin.
48. That the petitioner’s representative interviewed the respondent’s director of nursing on
September 13, 2005 who indicated the following:
a.
That the director of nursing completed resident number one’s September 2005
medication observation record;
That information for the medication observation record is obtained from the
previous month’s physician’s orders;
That upon review, the director of nursing acknowledged that there was extant a
discrepancy between the September 2005 medication observation record and
physician’s orders of record;
That perhaps the September 2005 medication administration record had been
copied from August 2005 record without checking the current physician’s orders
or that another staff member had entered the August 2005 information on the
medication administration records with the incorrect information;
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e. That the director of nursing acknowledged at 4:20 PM that the director of nursing
had copied and entered incorrect information on the medication record of
September 2005 in regards to the sliding scale of insulin dosages to be
administered.
49. That the Petitioner’s representative interviewed Resident number one (1) on September
13, 2005 and noted the following:
a. That the resident was alert and oriented;
b. That the resident indicated that the resident returned from the hospital on
September 9, 2005 and that the resident had been told by family that at the time
that the resident was transported to the hospital, the resident was comatose;
c. That the resident could not recall anything that occurred in the hospital due to the
severity of illness;
d. That the resident had, in the past, kept records of the dates and amounts of insulin
administered prior to hospitalization but has not done so since readmission due to
the resident’s not feeling well;
e. That the resident could not recall if the resident’s glucose was high on September
11, 2005 or if regular insulin coverage was administered on September 12, 2005;
f. That the resident usually received insulin administrations, though the resident is
unaware of the amounts administered.
50. That the Petitioner’s representative interviewed the Respondent's registered nurse on
September 13, 2005, who indicated as follows:
a. That the nurse worked the 3:00 PM to 11:00 PM shift on September 11, 2005;
b. That the nurse was identified as the nurse who had administered the resident’s
accu-check on September 11, 2005;
Cc. That the nurse sometimes administers insulin to the resident as do other nurses;
d. That the procedure utilized is to check the glucose level and, if high, to administer
insulin in accord with the sliding scale contained on the medication administration
record, and document these activities.
51. That the Respondent’s registered nurse later contacted the Petitioner’s representative on
September 13, 2005 and added the following information:
a. That the nurse had recalled the administration of insulin to resident number one
(1) on September 11, 2005 at 5:00 PM;
b. That the nurse had annotated the resident’s medication administration record to
reflect the administration of six (6) units of insulin at 5:00 PM on September 11,
2005;
c. That the nurse had been informed that the insulin administration on the sliding
scale had been incorrect on September 11, 2005 and that the six (6) units
administered were not in accord with physician’s orders which would have
required only three (3) units;
52. That the Petitioner’s representative reviewed the Respondent’s medication administration
record for resident number one (1) after having been informed by the Respondent’s registered
nurse of the late entry reflecting an insulin administration on September 11, 2005 and noted the
following:
a. That the record had since been amended to reflect the administration of insulin;
b. That the late entry by the Respondent's registered nurse had been made, but had
not been annotated in any mamner to reflect that the entry had not been made
contemporaneously with the administration of the medication;
c. That the resident’s blood sugar level at 5:00 PM on September 13, 2005 had been
annotated at two hundred eighty-six (286);
d. That the physician’s order, and the sliding scale entered on the medication
administration record, would call for the administration of six (6) units of insulin;
e. That the medication record had been annotated to reflect that the resident had been
administered three (3) units of insulin.
53. That the above reflects a series of errors constituting medical neglect including, but not
limited to, the failure of the Respondent facility to ensure that the medication administration
record for resident number one (1) accurately reflected the sliding scale for the insulin required
for the resident, the Respondent facility’s improper administration of insulin in accord with that
sliding scale even after the record had been corrected, the failure to administer and record the
administration of insulin on September 11 and 12, 2005, and the failure of the Respondent’s
registered nurse to accurately reflect the nurses treatment of the resident in the resident’s records.
54. That the Respondent’s registered nurse made a late entry to the resident’s record which
was not identified as such, that reflected a purported memory that was inconsistent with the
physician’s orders on the record at the time of the purported administration and as such would
have been a significant medication error.
55. That under either scenario which may be gleaned from the Respondent’s registered
murse’s statements and annotations, Resident number (1) was not appropriately treated for a
diabetic condition in accord with the prescribed sliding scale of insulin administration.
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56. That the above facts, individually and collectively, constitute medical neglect of resident
number one (1) in violation of law.
57. That the Petitioner’s representative reviewed the Respondent’s records regarding resident
number seven (7) which reflected the following:
a.
That the resident’s medication record for September 2005 reflected that the
resident was to receive accu-checks for blood glucose level monitoring once in the
morming and once in the afternoon with other accu-checks as needed;
That the resident was to receive the following insulin administrations:
Novolin N 100U inject 22U SubQ in the AM
Novolin N 100U inject 10U SubQ in the PM;
That additional insulin coverage was to be administered if the resident’s blood
sugar levels were in the following ranges:
Humulin R 100U Sliding Scale as follows
0-151=0 U
151-200=2U
201-250=4U
251-300=6U
301-350=8U
351-400=10U
Call MD if greater than 400
That the resident’s medication record reflected that the resident’s blood sugar
level was one hundred fifty-one on September 1, 2005 at 4:00 PM;
That in accord with the prescribed sliding scale, the resident should have been
administered two (2) units of insulin;
That the medication record was devoid of any indication that the prescribed
insulin was administered to the resident;
g. That the resident’s medication record reflected that the resident’s blood sugar
level was one hundred sixty-three (163) on September 12, 2005 at 7:00 AM;
h. That in accord with the prescribed sliding scale, the resident should have been
administered two (2) units of insulin;
f That the medication record was devoid of any indication that the prescribed
insulin was administered to the resident.
58. That the Petitioner’s representative reviewed the Respondent’s records regarding resident
number eight (8) which reflected the following:
a.
That the resident’s medication record for September 2005 reflected that the
resident was to receive accu-checks for blood glucose level monitoring four times
daily;
That the resident was to receive the following insulin administrations:
Novolin 70/30 100U inject 47U SubQ in the AM
Novolin 70/30 100U inject 20U SubQ in the PM;
That additional insulin coverage was to be administered if the resident’s blood
sugar levels were in the following ranges:
Humulin R 100U Sliding Scale as follows
0-151=0 U
151-200=3U
201-250=5U
251-300=7U
301-350=9U
351-400=11U ;
Call MD if less than 60 or greater than 400
That the resident’s medication record reflected that the resident’s blood sugar
level was one hundred fifty-four (154) on September 12, 2005 at 7:00 AM;
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e. That in accord with the prescribed sliding scale, the resident should have been
administered three (3) units of insulin;
f That the medication record was devoid of any indication that the prescribed
insulin was administered to the resident.
59. That the Petition’s representative interviewed resident number eight (8) on September 13,
2005 and noted an alert and oriented individual who does not recall a high blood glucose, with
glucose levels not high in the morning, but usually hi gh at lunch time.
60. That the Petitioner’s representative interviewed the Respondent’s nurse identified as the
individual who conducted the accu-checks for residents numbered seven (7) and eight(8) who
indicated the following:
a. That the nurse worked the morning shift on September 12, 2005;
b. That she could not recall an accu-check that was high;
c. That had a blood sugar reading been high, insulin coverage would have been
provided;
d. That some residents take medications by mouth.
61. That the above facts, individually and collectively, constitute medical neglect of resident
number one (1) in violation of law.
62. That the agency determined that the above constitutes grounds for the imposition of a
Class I deficiency in that it presents 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.
63. That the Respondent has violated the provisions of law regarding resident’s rights by
medical neglect and privacy violations as recited herein as cited by the Agency on both its June
21
17, August 24, and September 13, 2005 surveys, said violations presenting present and imminent
danger to the residents.
64. That pursuant to Section 400.419(2)(a), Florida Statutes (2005), the Agency is authorized
to impose a fine in the amount of ten thousand dollars ($10,000).
65. That the Agency provided the Respondent with a mandatory correction date of September
14, 2005.
WHEREFORE, the Agency intends to impose an administrative fine in the amount of
$10,000.00 against Respondent, an assisted living facility in the State of Florida, pursuant to §
400.419(2)(a), Fla. Stat, (2005).
Respectfully submitted this _/ / day of January, 2006.
Senior Attorney
Agency for Health Care Administration
525 Mirror Lake Drive, 330G
St. Petersburg, FL 33701
Respondent is notified that it has a right to request an administrative hearing pursuant to Section
120.569, Florida Statutes (2005). Specific options for administrative action are set out in the
attached Election of Rights (two pages) 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 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.
N
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CERTIFICATE OF SERVICE
THEREBY CERTIFY that a true and correct copy of the foregoing has bee ed by
USS. Certified Mail, Return Receipt No. 7003-1010-0002 4667 0982 on January ij , 2006
to: NRAI Services, Inc. Registered Agent, 2731 Executive Park Dr., #4, Weston, FI. 33331 and
by U.S. Mail to Julie S. Fernandez, Administrator, The Gables of Lake Mary, 3655 W. Lake
Mary Blvd., Lake Mary, FL 32746.
Th . Walsh, I, Esq.
Copies furnished to:
NRAI Services, Inc. Julie S. Fernandez Thomas J. Walsh, I, Esq.
Registered Agent Administrator Agency for Health Care Admin.
2731 Executive Park Dr. #4 The Gable of Lake Mary 525 Mirror Lake Drive, 330G
Weston, FL 33331 3655 W. Lake Mary Blvd St. Petersburg, FL 33701
(U.S. Certified Mail) Lake Mary, FL 32746 (Interoffice)
(U.S. Mail)
23
PAYMENT FORM
Agency for Health Care Administration
Finance & Accounting
Post Office Box 13749
Tallahassee, Florida 32317-3749
Enclosed please find Check No. in the
amount of $ which represents payment of the
Administrative Fine imposed by AHCA.
The Gables of Lake Mary 2005008010/ 2005008842
Facility Name ; AHCA No.
STATE OF FLORIDA a i
AGENCY FOR HEALTH CARE ADMINISTRATION "Fa EP
ia es
OG
EXPLANATION OF RIGHTS UNDER SEC. 120.569, FLORIDA STATUTES AR
DR
ile
(To be used with Election of Rights for Administrative Complaint form — attacheti),) Hey oe
ts vy fy st
In response to the allegations set forth in the Administrative Complaint issued by the agen gang lVE
Health Care Administration (‘AHCA" or “Agency"), Respondent must make one of the following
elections within twenty-one (21) days from the date of receipt of the Administrative Complaint
and 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. Please make your election on the
attached Election of Rights form and return it fully executed to the address listed on the form.
OPTION 1. If Respondent does not dispute the allegations in the Administrative Complaint
and Respondent elects to waive the right to be heard, Respondent should select OPTION 1 on
the election of rights form. A final order will be entered setting forth the allegations as being
deemed admitted and imposing the penalty sought in the Administrative Complaint. You will be
provided a copy of the final order.
OPTION 2. _ If Respondent does not dispute any material fact alleged in the Administrative
Complaint (Respondent admits all the material facts alleged in the Administrative Complaint.),
Respondent may request an informal hearing pursuant to Section 120.57(2), Florida Statutes
before the Agency. At the informal hearing, Respondent will be given an opportunity to present
both written and oral evidence to reduce the penalty being imposed for the violations set out in the
Complaint. For an informal hearing, Respondent should select OPTION 2 on the Election of Rights
form.
OPTION 3. __ If the Respondent disputes the allegations set forth in the Administrative Complaint
(you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida
Statutes. To obtain a formal hearing, Respondent should select OPTION 3 on the Election of
Rights form.
In order to obtain a formal proceeding before the Division of Administrative Hearings under
Section 120.57(1), F.S., Respondent's request for an administrative hearing must conform to
the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state
the material facts disputed. If you select Option 3, mediation may be available in this case
pursuant to Section 120.573, Florida Statutes, if all parties agree to it.
IF YOU SELECT OPTION 3, PLEASE CAREFULLY READ THE FOLLOWING PARAGRAPH:
In order to preserve the right to a hearing, Respondent’s original Election of Rights in
this matter must be RECEIVED by AHCA within twenty-one (21) days from the date
Respondent receives the Administrative Complaint. if the election of rights form with
Respondent's selected option is not received by AHCA within twenty-one (21) days from
the date of Respondent’s receipt of the Administrative Complaint, a final order will be
issued finding the deficiencies and/or violations charged and imposing the penalty
sought in the Complaint.
Docket for Case No: 06-000793
Issue Date |
Proceedings |
Sep. 06, 2006 |
Final Order filed.
|
Jun. 09, 2006 |
Order Closing Files. CASE CLOSED.
|
Jun. 08, 2006 |
Motion to Relinquish Jurisdiction filed.
|
May 30, 2006 |
Notice of Filing Petitioner`s Response to Respondent`s Request to Produce filed.
|
May 30, 2006 |
Notice of Filing of Petitioner`s Unsigned Answers to Respondent`s Interrogatories filed.
|
Apr. 28, 2006 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for June 22 and 23, 2006; 9:30 a.m.; Sanford, FL).
|
Apr. 27, 2006 |
Respondents` Unopposed Motion for Continuance of Final Hearing Due to Family Emergency filed.
|
Apr. 26, 2006 |
Amended Administrative Complaint filed.
|
Apr. 13, 2006 |
Notice of Service of Defendant`s Initial Assited Living Facility Interrogatories to Plaintiff filed.
|
Apr. 13, 2006 |
Defendant`s First Request for Production filed.
|
Apr. 03, 2006 |
Notice of Service of Petitioner`s First Set of Interrogatories, Request for Admissions and Request for Production of Documents to Respondent filed.
|
Mar. 17, 2006 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for May 10 and 11, 2006; 9:30 a.m.; Sanford, FL).
|
Mar. 17, 2006 |
Order Granting Consolidation (DOAH Case Nos. 06-0375 and 06-0793).
|
Mar. 13, 2006 |
Joint Response to Initial Order and Joint Motion to Continue and Consolidate (with Case No. 06-0375) filed.
|
Mar. 06, 2006 |
Initial Order.
|
Mar. 03, 2006 |
Administrative Complaint filed.
|
Mar. 03, 2006 |
Election of Rights filed.
|
Mar. 03, 2006 |
Request for Formal Administrative Hearing Regarding Administrative Complaint dated January 19, 2006 filed.
|
Mar. 03, 2006 |
Notice (of Agency referral) filed.
|