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Wel HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2005010159 ABIMBOLA OGUN, d/b/a SHADY OAKS OF CURLEW, respondent OL: dIdTY ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against ABIMBOLA OGUN, d/b/a SHADY OAKS OF CURLEW (hereinafter “Respondent”), pursuant to Sections 120,569, and 120.57, Florida Statutes, (2005), and alleges: NATURE OF THE ACTION This is an action to revoke the Respondent’s license to operate an assisted living facility or, in the alternative, to impose administrative in the sum of TWENTY-EIGHT THOUSAND FIVE HUNDRED AND NO/100 DOLLARS ($28,500.00) based upon four (4) Class I violations cited pursuant to Sections 400.419(2)(a), Florida Statutes (2005), and eight (8) Class II violations, cited pursuant to Sections 400.419(2)(b), Florida Statutes (2005), and complaint survey fee in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to Section 400.419(10), Florida Statutes (2005). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to Sections 20.42, 120.60 and 400.407, Florida Statutes (2005). 2. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code (2005). PARTIES 3. The Agency is the regulatory authority responsible for licensure of assisted living facilities and enforcement of all applicable regulations, statutes and rules governing assisted living facilities pursuant to Chapter 400, Part II, Florida Statutes, and Chapter 58A-5, Florida Administrative Code. 4. Respondent operates a 25-bed assisted living facility located at 1889 Curlew Road, Palm Harbor, Florida 34683, and is licensed as an assisted living facility (License # 9237). 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. COUNTI 6. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and the remainder of this Administrative Complaint as if fully recited herein. 7. Pursuant to Section 400,414(1)(e), Florida Statutes (2005), the Agency may revoke any license issued under Chapter 400, Part II, Florida Statutes for the citation of one (1) or more cited class I deficiencies, three (3) or more cited class II deficiencies, or five (5) or more cited class III deficiencies that have been cited on a single survey and have not been corrected within the specified time period. 8. During a survey of the Respondent conducted on or about October 27, 2005, the Agency cited the Respondent for four (4) Class I violations pursuant to Sections 400.41 9(2)(a), Florida Statutes (2005), and eight (8) Class II violations pursuant to Sections 400.419(2)(b), Florida Statutes (2005). 9. Based upon the existence of any one (1) of the cited Class I violations or any three (3) or more of the cited Class II deficiencies, the Agency seeks the revocation of the Respondent’s assisted living facility license as its primary relief herein, seeking the assessment of fines solely in the alternative. 10. Should the Respondent admit the facts herein by action or inaction, the Petitioner shall enter an Order revoking the Respondent’s licensure in lieu of other relief sought herein. WHEREFORE, the Agency intends to revoke the Respondent’s license to operate an assisted living facility in the State of Florida, pursuant to Section 400.414(1)(e), Florida Statutes (2005). COUNT I 11. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully recited herein. 12. Pursuant to Rule 58A-5.0181(1)(j), Florida Administrative Code (2005), in order to be admitted to an assisted living facility, an individual must not have any stage 3 or 4 pressure sores. However, pursuant to that same rule, an individual suffering from a stage 2 pressure sore may be admitted to an assisted living facility provided that: (1) the facility must have a limited nursing services license and provide services pursuant to a plan of care issued by a physician, or the resident contracts directly with a licensed home health agency or nurse to provide care, (2) the condition is documented in the resident’s record, and (3) if the resident’s condition fails to improve within thirty days, the resident shall be discharged from the facility 13. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”). 14. Based upon record review and interview, the Agency determined that the Respondent failed to ensure that an individual admitted to the F acility was free from stage 3 pressure sores, in violation of Rule 58A-5.0181(1)(j), Florida Administrative Code (2005). 15. Record review conducted during the October 27, 2005, survey revealed that Resident #1 was initially admitted to the Facility on or about April 26, 2004. 16. A Resident Health Assessment dated April 12, 2004, indicated that Resident #1 was diagnosed with uncontrolled Parkinson’s disease, had a history that included a coronary artery bypass graft, and was fitted with a Pacemaker. 17. According to a Resident Health Assessment dated April 12, 2005, Resident #1 required supervision for ambulation, bathing, dressing, toileting, grooming, and transferring. Resident #1 was assessed to eat independently, as no supervision or assistance was required for such activity. 18. An entry in the Resident Observation Log (hereinafter “ROL”) on February 11, 2005, revealed that Resident #1 was transferred to a hospital, but did not indicate the reason for such transfer. The next entry in the ROL for Resident #1 was dated April 20, 2005. 19. In an interview conducted October 26, 2005, the Administrator indicated that the reason Resident #1 was transferred to the hospital on February 11, 2005, was that the resident had fallen and fractured a hip. In that same interview, the Administrator indicated that there was no major incident report prepared with regard to Resident #1’s fall. 20. Further record review revealed that, from February 15, 2005, through April 20, 2005, Resident #1 was admitted to a nursing home where he/she was evaluated for care and service needs. 21. Review of Resident #1’s nursing home record revealed a Nursing Admission Evaluation, dated February 15, 2005, which indicated that that resident was admitted to the nursing home following a left hip fracture. In addition, there was documentation that the resident had a stage 4 pressure sore on his/her sacral area and bi-lateral mushy heels with blisters. 22, The Nursing Admission Evaluation included a Braden Scale for Predicting Pressure Sore Risk, dated February 15, 2005, which revealed a score of seventeen (17). Such score indicates that Resident #1 was at risk for pressure sores. 23. Review of Resident #1’s nursing home.record revealed an Ongoing Skin ’ Alteration Report, dated February 17, 2005, which indicated Resident #1 had a 9 x 8 centimeter stage 4 pressure ulcer that was .01 centimeters deep on the sacrum. It revealed that necrosis was present. 24. Review of Resident #1’s nursing home record revealed other Ongoing Skin Alteration Reports, also dated February 17, 2005, which indicated Resident #1 had stage 1 pressure ulcers on his/her right and left heels. 25. While in the nursing home, the Resident #1 received on-going wound care and therapy services. 26. Discharge orders written on April 19, 2005, revealed that Resident #1 was to return to the Facility on April 20, 2005, with orders to receive physical and occupational therapy. The orders indicate that, at the time of discharge, Resident #1 was 5 feet 7 inches tall and weighed 118.4 pounds. 27. ‘Ina Resident Health Assessment dated April 2005, a physician indicated that Resident #1 did not have any pressure sores upon his/her return to the Facility. 28. In an interview conducted October 24, 2005, at approximately 4:15 p.m., a family member of Resident #1 also indicated that Resident #1 did not have any pressure sores upon retuming to the Facility from the nursing home on April 20, 2005. 29. Anentry in the Facility’s ROL for Resident #1, dated April 20, 2005, indicated that that resident returned to the Facility with a change in medications and a decubitus ulcer noted on the sacral area. 30. The next entry in the Facility’s ROL for Resident #1 was dated April 30, 2005. It indicated that the Administrator contacted a home health agency to have a nurse come in assess a decubitus ulcer on Resident #1’s sacrum. 31. An entry in the ROL dated May 4, 2005, indicated that a dry dressing was on Resident #1’s sacral area, that Facility staff were instructed to keep such dressing dry, and that the rationale for doing so was explained to Facility staff. 32. | The members of the Facility staff that were responsible for Resident #1 were resident assistants and did not have adequate medical training to properly change dressing to a wound. In addition, there was no Facility documentation indicating what steps those resident assistants should take if they were to find Resident #1’s dressing to be saturated. 33. Anentry in the ROL dated May 4, 2005, indicated that the Administrator talked to the home health agency nurse who was providing care to Resident #1 and indicated to that nurse that twice per week visits to tend to Resident #1’s wound care were insufficient to promote proper healing and may promote infection. 34, In an entry in the ROL dated May 10, 2005, the Administrator documented the following in regard to Resident #1’s sacral decubitus ulcer: “Wound decompensating increase drainage noted.” 35. The last entry on the ROL, dated May 11, 2005, indicated that a physician was notified about Resident #1's decubitus uclcer and that an appointment was scheduled for that resident to see the physician in the office on May 12, 2005. 36. Record review conducted during the October 27, 2005, survey revealed that Resident #1 was initially admitted to Mease Countryside Hospital (hereinafter “Hospital”) on May 13, 2005. 37. According to an interview with a family member of Resident #1, that resident went to the Hospital after exhibiting signs and symptoms of dehydration and developing a pressure sore on his/her sacrum. 38. According to Resident #1’s discharge summary from the Hospital, the resident was admitted to the Hospital on May 13, 2005, with the following admitting diagnoses: dehydration, generalized weakness, an infected decubitus ulcer, advanced Parkinson’s disease, and a history of a left hip fracture. ‘39. A Hospital document dated May 15, 2005, indicated the presence of Stage 3 decubitus ulcers on Resident #1’s coccyx and foot. In addition, Hospital documentation from Resident #1’s stay at the Hospital indicated the presence of skin wounds on each of Resident #1’s heels. 40. At no point did the Facility’s ROL address the status of Resident #1’s heels between April 20, 2005, and May 13, 2005. 41. According to a Hospital document dated May 17, 2005, and entitled “Infectious Disease Consultation,” Resident #1 was “admitted with generalized weakness and an infected decubitus ulcer from the assisted living facility where he/she lives. A superficial culture of his/her sacral decubitus grew pseudomonas, Escherichia coli, and Enterococcus faecalis.” That consultation further indicated that: “Examination of the coccygeal area shows a 6 x 8 cm lesion Stage IIT with a little yellowish eschar.” 42. Record review revealed a new Resident Health Assessment, completed on May 17, 2005, that indicated that: a. Resident #1 had an infected sacral decubitus ulcer; b. Resident #1 required assistance with medications and transfers; c. Special precautions should be taken with regards to both falls and decubitus ulcers for Resident #1; and d. Resident #1 suffered from Stage 2, 3, or 4 pressure sores, 43. The Hospital “Discharge Summary,” dated May 19, 2005, indicated that Resident #1 “was transferred back to his/her ALF in a stable condition...” Under the heading “Discharge Diagnoses,” that same document listed the following for Resident #1: dehydration, generalized weakness, infected decubitus ulcer, pacemaker, hypothyroidism, advanced Parkinson disease, history of left hip fracture, peptic ulcer disease, and osteoporosis. 44. Although Hospital documents indicate that Resident #1 returned to the Facility on May 19, 2005, there was no similar entry in the Facility’s ROL noting Resident #1’s return. 45. The most recent entry concerning the stage of Resident #1’s sacral decubits ulcer in Hospital records was found in the May 17, 2005, Infectious Disease Consultation, which indicated that that decubitus ulcer was at stage 3. 46. In an interview conducted on or about October 26, 2005, at approximately 2:15 p.m., the Facility administrator (hereinafter “Administrator”) indicated that Resident #1 was in stable condition when he/she was readmitted to the Facility on May 19, 2005. During that same interview, the Administrator denied that Resident #1’s infected sacral decubitus ulcer was a stage 3 pressure sore at the time of that resident’s readmission. 47. In an interview conducted on or about October 24, 2005, at approximately 4:15 p.m., a family member of Resident #1 indicated that she was informed by the Administrator that the Administrator had fired the home health agency that had been taking care of Resident #1 in early May 2005, and that, upon the resident's return to the Facility on May 19, 2005, the Administrator had become certified to perform the Resident #1’s wound care, and would be taking over such responsibility. That same family indicated that the Administrator offered repeated assurances that Resident #1’s sacral decubitus ulcer was improving. 48. In an interview conducted on or about October 24, 2005, at approximately 4:15 p.m., a family member of Resident #1 indicated that upon going to visit Resident #1 on J uly 18, 2005, Resident #1 appeared very pale and confused. This prompted the family member to contact the attending physician, who indicated that Resident #1 should be taken to the Hospital. 49. In an interview with a family member of Resident #1, the family member indicated that when the nurse at the Hospital removed the dressing from Resident #1’s sacral area, the smell and odor were overpowering and the decubitus pressure ulcer appeared to penetrate to Resident #1’s bone. 50. Review of the Hospital record for Resident #1’s July 18, 2005, admission revealed an “Emergency Triage/Assessment Form,” which indicated that the resident had three (3) pressure ulcers. 51. A July 18, 2005, culture of Resident #1’s sacral pressure sore, performed at the Hospital, revealed that the resident had heavy growth Escherichia coli, heavy growth Acinetobacter baumannii, moderate growth Bacteroides thetatiotaomicron, plus normal endogenous flora present. 52. A Hospital document entitled “Patient Progress Record,” dated July 18, 2005, revealed that Resident #1 was “ill-appearing, cheeks/eyes sunken in. Pt. appears emaciated. Stage 3 decubitus on sacrum with black tissue and purulent drainage. Right heel decub - Stage 3, approximately 3 and a half cm. in diameter, also necrotic tissue and purulent drainage.” 53. The presence of multiple stage 3 decubitus ulcers upon the July 18, 2005, admission to the Hospital from the Facility necessitates the conclusion that Resident #1 suffered those same stage 3 pressure sores while still residing at the Facility. 54, On July 20, 2005, while still at the Hospital, Resident #1 had to undergo debridement of the pressure ulcers. 55. The Preoperative Diagnosis for Resident #1’s debridement noted “Necrotic sacral decubitus, Necrotic right heel decubitus. Findings: There was foul purulent material, which extended superiorly and inferiorly from the necrotic area, which was ultimately about 8 x 8 cm. There was relatively dry necrosis of the right heel decubitus. The underlying subcutaneous tissue had reasonable bleeding although it was abnormal.” 56. In an interview conducted October 24, 2005, at approximately 4:15 p.m., a family member of the Resident #1 indicated that the resident required a feeding tube insertion for nourishment purposes on July 22, 2005. 57. Hospital records indicate that Resident #1 expired in the Hospital on August 14, 2005. 10 358. Resident #1’s family member indicated that the death certificate for that resident listed decubital ulcer, failure to thrive, and malnutrition as contributing factors to the resident’s death. 59. Subsequent record review revealed that from the time of Resident #1’s readmission to the Facility on May 19, 2005, continuing through July 18, 2005, the date on which Resident #1 was again transferred to the Hospital, there were no ROL entries for Resident #1 in the resident file maintained by the Facility. 60. In an interview conducted October 26, 2005, at approximately 3:30 p.m., the Administrator indicated that she had hired a home health agency to care for Resident #1’s wounds and for that reason did not have documentation concerning Resident #1 from the time of that resident’s readmission to the F acility on May 19, 2005, through J uly 18, 2005, the date on which that resident was again transferred to the Hospital. 61. In an interview with a family member of Resident #1, conducted October 24, 2005, the family member indicated that he/she had contacted the home health agency that had been providing wound care to Resident #1 prior to that resident’s admission to the Hospital on May 13, 2005. The family member asserts that, as a result of her discussions with individuals at the home health agency, she learned the home health agency had not been fired by the Administrator, but that they had complained to the Administrator that Resident #1 required placement in a skilled nursing facility. The family member further asserts that after the Administrator ignored such pleas, an individual from the home health agency contacted the Facility’s resident physician. 62. Based upon the above, the Agency determined that the Respondent, on or about May 19, 2005, admitted to its Facility an individual (Resident #1) with a stage 3 pressure sore, in violation of Rule 58A-5.0181(1)(j), Florida Administrative Code (2005). 63. In addition, even if on the May 19, 2005, date of admission Resident #1 suffered from only a stage 2 pressure sore, the Respondent, in order to admit Resident #1 to the Facility, was required to document that resident’s condition in the Facility record pursuant to Rule 58A- 3.0181(1)G)(2), Florida Administrative Code (2005). Accordingly, the absence of any F; acility documentation concerning Resident #1’s decubitus pressure ulcer upon readmission on May 19, 2005, is a violation Rule 58A-5.0181(1)()(2), Florida Administrative Code (2005). 64. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security of the Facility residents. 65. The Agency cited the Respondent for a Class II violation in accordance with Section 400.419(2)(b), Florida Statutes (2005). 66. The Agency provided a mandated correction date of November 4, 2005. 67. Respondent’s admission of an individual with a stage 3 pressure sore, in violation of Rule 58A-5.0181(1)(j), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(b), Florida " Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(b), Florida Statutes (2005). COUNT I 68. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Thirteen (13) through Sixty-One (61) as if fully recited herein. 69. Pursuant to Rute 58A-5.0181(1)(m), Florida Administrative Code (2005), the administrator of an assisted living facility is required to determine whether an individual is appropriate for admission and is required to base such determination upon: (1) an assessment of the strengths, needs, and preferences of the individual, and the medical examination report required by Section 400.426, Florida Statutes, and subsection (2) of Rule 58A-5 .0181, Florida Administrative Code; (2) the facility’s admission policy, and the services the facility is prepared to provide or arrange for to meet resident needs; and (3) the ability of the facility to meet the uniform fire safety standards for assisted living facilities established under Section 400.441, Florida Statutes, and Chapter 44-40, Florida Administrative Code. 70. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”), 71. As illustrated by the facts incorporated in this count, the Respondent did not assess Resident #1’s pressure sore(s), as evidenced by its failure to document any such assessment, and did not possess staff adequately trained to perform services, as evidenced by the inability to care for Resident #1’s wounds to promote health. 72. As a result of record review and observation during the October 27, 2005, survey, the Agency determined that the Respondent failed to ensure that the Administrator based her determination to admit Resident #1, on or about May 19, 2005, upon Resident #1’s need to receive adequate care of a decubitus pressure ulcer(s) and the ability of the Facility to meet such needs, in violation of Rule 58A-5.0181( 1)(m)(1) and (2), Florida Administrative Code (2005). 73. The Agency determined that this deficient practice was related to the operation 13 and maintenance of the Facility or to the personal care of Facility residents and presented 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. 74. The Agency cited the Respondent for a Class I violation in accordance with Section 400.419(2)(a), Florida Statutes (2005). 75. The Agency provided a mandated correction date of October 27, 2005. 76. Respondent's failure to ensure that the Administrator based her determination to admit Resident #1, on or about May 19, 2005, upon Resident #1’s need to receive adequate care of a decubitus pressure ulcer(s) and the ability of the Facility to meet such needs, in violation of Rule 58A-5.0181(1)(m)(1) and (2), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE THOUSAND AND NO/100 DOLLARS ($5000.00), pursuant to Section 400.419(2)(a), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of FIVE THOUSAND AND NO/100 DOLLARS ($5000.00), against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(a), Florida Statutes (2005). COUNT IV 77. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Thirteen (13) through Sixty-One (61) as if fully recited herein. 78. Pursuant to Rule 58A-5.01 81(4)(b)(2), Florida Administrative Code (2005), in order for an individual to be retained at an assisted living facility while suffering from a stage 2 pressure, the assisted living facility must ensure, inter alia, that the condition is documented in the resident’s record. 79. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”). 80. Asa result of record review and observation during the October 27, 2005, survey, the Agency determined that the Respondent, between May 19, 2005, and July 18, 2005, retained in residence an individual (Resident #1) suffering from a at least a stage 2 pressure sore without ensuring that such condition was documented in the resident’s record, in violation of Rule 58A- 5.0181(4)(b)(2), Florida Administrative Code (2005). 81. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security of the F acility residents. 82, Accordingly, the Agency determined that the above-described deficient practice warrants citing the Respondent for a Class II violation in accordance with Section 400.419(2)(b), Florida Statutes (2005). 83. Respondent’s retention in residence of an individual with a stage 3 pressure sore, without ensuring that such condition was documented resident’s record, in violation of Rule 58A-5.0181(4)(b)(2), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/i100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(b), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(b), Florida Statutes (2005). 15 COUNT V 84. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Thirteen (13) through Sixty-One (61) as if fully recited herein. 85. Pursuant to Rule 58A-5.0181(4)(b)(3), Florida Administrative Code (2005), an individual may be retained in residence at an assisted living facility only if, inter alia, the resident is discharged from the facility if his/her condition fails to improve within thirty (30) days. 86. As aresult of record review and observation during the October 27, 2005, survey, the Agency determined that, between May 19, 2005, and July 18, 2005, the Respondent retained in residence an individual (Resident #1) suffering from a at least a stage 2 pressure sore, which failed to improve during a period of time in exceeding thirty (30) days during, in violation of Rule 58A-5.0181(4)(b)(3), Florida Administrative Code (2005). 87. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security of the Facility residents. 88. The Agency cited the Respondent for a Class II violation in accordance with Section 400.419(2)(b), Florida Statutes (2005). 89. The Agency provided a mandated correction date of November 4, 2005. 90. Respondent’s retention in residence of an individual (Resident #1) with at least a Stage 2 pressure sore for a period of time exceeding thirty (30) days, during which time the resident’s condition did not improve, in violation of Rule 58A-5.0181(4)(b)(3), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(b), Florida Statutes (2005). 16 WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(b), Florida Statutes (2005). COUNT VI 91. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and Thirteen (13) through Sixty-One (61) as if fully recited herein. 92, Pursuant to Rule 58A-5.0181(4)(d), Florida Administrative Code (2005), the administrator of an assisted living facility is responsible for monitoring the continued appropriateness of placement of residents of the facility. 93. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent's assisted living facility (hereinafter “Facility”). 94, As a result of record review and observation during the October 27, 2005, survey, the Agency determined that the Respondent failed to ensure that its administrator (hereinafter “Administrator’”) continuously monitor the appropriateness of placement of a resident of the Facility (Resident #1), in violation of Rule 58A-5.0181(4)(d), Florida Administrative Code (2005), as evidenced by the Administrator permitting the continued residence of Resident #1 during the period of May 19, 2005, through July 18, 2005, despite the presence of multiple stage 3 pressure sores, which were noted during Resident #1’s ultimate admission to a hospital on July 18, 2005. 95. The Agency further determined that the Respondent either (1) retained Resident #1 while such resident had at least a stage 2 decubitus pressure ulcer for a period in excess of thirty (30) days, and/or (2) retained Resident #1 while such resident had a stage 3 decubitus pressure ulcer. In either such instance, the continued residency of Resident #1 was inappropriate and contrary to Florida law. 96. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of Facility residents and presented 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. 97. The Agency cited the Respondent for a Class I violation in accordance with Section 400.419(2)(a), Florida Statutes (2005). 98. The Agency provided a mandated correction date of November 4, 2005. 99. Respondent’s failure to ensure that the Administrator appropriately monitored Resident #1 to determine whether such individual was appropriately placed in the Facility, in violation of Rule 58A-5.0181(4)(d), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE THOUSAND AND NO/100 DOLLARS ($5000.00), pursuant to Section 400.419(2)(a), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of FIVE THOUSAND AND NO/100 DOLLARS ($5000.00), against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(a), Florida Statutes (2005). COUNT VII 100. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully recited herein. 101. Pursuant to Rule 58A-5.019(1), Florida Administrative Code (2005), every assisted living facility shall be under the supervision of an administrator who is responsible for 18 the operation and maintenance of the facility, including the management of all staff and the provision of adequate care to all residents. 102. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”). Resident #1 103. The Agency re-alleges and incorporates Paragraphs Thirteen (13) through Sixty- One (61) as if fully recited herein. 104. As aresult of record review and interview during the October 27, 2005, survey, the Agency determined that the Respondent, through its Administrator, failed to properly manage all staff with regards to Resident #1 and/or provide adequate care to Resident #1, in violation of Rule 58A-5.019(1), Florida Administrative Code (2005), as evidenced by the Administrator’s failure to: (1) appropriately care for Resident #1’s decubitus ulcers, (2) ensure that Facility staff were appropriately trained to care for Resident #1*s decubitus ulcers, (3) continuously monitor Resident #1 for appropriateness of placement in the F: acility, (4) recognize that Resident #1 was not receiving adequate care or treatment for decubitus ulcers at the Facility, and (5) timely transfer such resident to a another type of health care facility where appropriate care could be properly rendered. Resident #4 105. Review of Resident #4's Health Care Assessment dated December 14, 2004, revealed that the resident required assistance with self-administration of medications. 106. According to the September and October 2005 medication observation records (hereinafter “MOR”) for Resident #4, that resident received the following medications on an “as 19 needed” basis as follows: a. Vicodin 5/500 Tablet — Take one (1) tablet by mouth every four (4) hours as needed. According to the MORs, the resident received sixteen (16) doses of this medication between September 11 and September 23, 2005, and fourteen (14) doses between October 20 and October 25, 2005. b. Ultracet Tablet - Tramadol HCL-Acetaminophen - Take one (1) to two (2) tablets by mouth every six (6) hours as needed. The resident received thirty-nine (39) doses of this medication on the September MOR, and eighty-two (82) doses of this medication between October 1 and October 25, 2005. The MOR does not indicate whether the resident received one (1) tablet or two (2) tablets at a time. Interview with the medication assistant on October 26, 2005, at approximately 11:40 a.m., revealed that she did not work at the Facility in the month of September, but the medications she gave in October were always only one (1) tablet. Cc. Ativan 1 mg, Tablet - Take one (1) tablet by mouth daily as needed. The resident received twenty-one (21) doses of this medication in the month of September. The resident received one (1) daily dose of this medication at 7:00 p.m. from October 4 through October 24, 2005. d. Potassium Chloride 20MEQ - Take one (1) tablet by mouth daily as needed when on Lasix. The resident received a dose on September 2 and 3, 2005. Interview with the medication assistant on October 26, 2005, at approximately 11:40 a.m., revealed that the resident had not received any doses of this medication in October because medication assistant was unsure for what reason the medication was prescribed. e. Lasix 40 mg. Tablet - Take one (1) tablet by mouth as needed. The resident received a dose on September 2 and 3, 2005. Interview with the medication assistant on October 26, 2005, at approximately 11:40 a.m., revealed that the resident had not received any doses of this medication in October because medication assistant was unsure for what reason the medication was prescribed. The medication assistant did state that she had contacted the pharmacy to send out information about the medications. f. Promethazine 25 mg - Take one (1) tablet every six (6) to eight (8) hours as needed (October MOR reads “Phenergan 25 mg. tablet”). The resident received the medication daily from September 16 through September 30, 2005. The resident received a total of thirty-seven (37) doses from October 1 through 25, 2005. There were not always time frames specified on the date given, but the resident had been receiving the medication up to two (2) times a day from October 9 through 24, 2005. Interview with the medication assistant on October 26, 2005, at approximately 11:40 a.m., revealed that she thought the Phenergan was for pain and that was why the resident had been receiving it more frequently. The assistant was unaware that the medication was generally given for complaints of nausea and vomiting. 107. In an interview conducted on or about October 26, 2005, at approximately 10:30 a.m., the Administrator confirmed that no new specific orders had been obtained from the health care provider for any of the above medications for Resident #4 that had been ordered “as needed.” 108. Observation of Resident #4 on October 26, 2005, at approximately 11:15 a.m., revealed that the resident was sitting in a recliner in the room with 2+ pitting edema in bi-lateral lower extremities. The Lasix is typically ordered by a health care provider to assist the body in ridding itself of fluids that create edema. Interview with the resident at that time also revealed that he/she had fallen on the floor getting up from the recliner that morning and, as a result, obtained a 2 cm. laceration to the upper left arm. The resident was unable to explain why he/she fell. Many of the above medications, when inappropriately utilized, greatly enhance the potential for falls. 109. In an interview conducted on or about October 26, 2005, at approximately 11:50 a.m., the Administrator confirmed that she had notified Resident #1’s son and physician of the resident’s fall. 110. Resident #4’s record contained a prescription, dated September 26, 2005, which tead “Miralax - Take 1 capful in 8 oz. of liquid 1-2 times a day.” 111. The MOR for September 2005 revealed that the order was transcribed to read, “Glycolax Powder - mix 1 capful in 8 ounces of liquid 1-2 times daily - PRN.” (PRN refers to receiving a medication “as needed” in medical abbreviations; Glycolax Powder is the generic form of Miralax). 112. The September 2005 MOR revealed the resident did not receive any Glycolax in that month. 113. The October 2005 MOR was transcribed to read, “Glycolax Powder - mix 1 cap full in 8 ounces of liquid 1-2 times a day.” 114. The October 2005 MOR revealed that Resident #4 received the prescribed Glycolax twice a day from October 6 through October 11, 2005, and once (at 8:00 a.m.) on October 12, 2005. 115. Following the single dose received on October 12, 2005, a note in the MOR directed that Resident #4 stop receiving Glycolax. 116. Review of physician’s orders for Resident #4 did not reflect that there was ever a stop order given by a health care provider with regards to the Glycolax. 117. In an interview conducted on October 26, 2005, at approximately 11:10 a.m., with the primary direct care staff revealed that the Resident #4 had a bowel movement so she thought it was acceptable to stop giving the medication. That same individual also confirmed there had not been any order to discontinue the medication issued by an appropriate health care provider. 118. On or about October 26, 2005, at approximately 10:00 a.m., an Agency surveyor contacted the advanced registered nurse practitioner (hereinafter “ARNP”) listed on Resident #4's MOR and relayed concern regarding the Glycolax medication being stopped without appropriate notification or order. No WwW 119. The ARNP stated that he wanted the Glycolax order continued and would immediately contact the Facility with such order. The ARNP did contact the Administrator and give the order that morning. . 120. Based on the above, the Agency determined that the Respondent, through its Administrator, failed to properly manage all staff with regards to Resident #4 and/or provide adequate care to Resident #4, in violation of Rule 58A-5 .019(1), Florida Administrative Code (2005), as evidenced by the Administrator’s failure to: (1) ensure that Resident #4 receive all prescribed medications as ordered, and (2) ensure that Facility staff is appropriately supervised and directed to provide care as ordered by various health care professionals. 121. The Agency determined that the above-described deficient practices were related to the operation and maintenance of the F acility or to the personal care of Facility residents and presented 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. 122, The Agency cited the Respondent for a Class I violation in accordance with Section 400.419(2)(a), Florida Statutes (2005). 123. The Agency provided a mandated correction date of November 4, 2005. 124. Respondent’s failure to ensure that its assisted living facility be under the supervision of an administrator who is responsible for the operation and maintenance of the facility, including the management of all staff and the provision of adequate care to all residents, in violation of Rule 58A-5 .019(1), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE THOUSAND AND NO/100 DOLLARS ($5000.00), pursuant to Section 400.41 9(2)(a), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of FIVE THOUSAND AND NO/100 DOLLARS ($5000.00), against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(a), Florida Statutes (2005). COUNT VU 125. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully recited herein. 126. Pursuant to Rule 58A-5.019(2)(b), Florida Administrative Code (2005), all assisted living facility staff must perform their responsibilities, consistent with their qualifications, to observe residents, to document observations on the appropriate resident record, and to report the observations to the resident’s health care provider. 127. In addition, pursuant to Rule S8A-5 .0182(1)(b), Florida Administrative Code (2005), assisted living facilities are required to offer daily observation of resident activity and an awareness of the general health, safety, and physical and emotional well-being of residents. 128. In addition, pursuant to Rule 58A-5.0182(1)(c), Florida Administrative Code (2005), assisted living facilities are required to have a general awareness of a resident’s whereabouts. 129. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”). Resident #1 130, The Agency re-alleges and incorporates Paragraphs Thirteen (13) through Sixty- One (61) as if fully recited herein. 131. As aresult of record review and interview during the October 27, 2005, survey, the Agency determined that Facility staff failed to perform their responsibilities, consistent with their qualifications, to observe, document observations, and/or report observations to the appropriate health care provider for Resident #1, in violation of Rule 58A-5 .019(2)(b), Florida Administrative Code (2005), as evidenced by Facility staff's failure to: (1) appropriately observe Resident #1’s decubitus ulcers, (2) document observations concerning the staging of Resident #1’s decubitus ulcers, (3) document any treatments/services concerning Resident #1’s decubitus ulcers, and/or (4) document any type of observation concerning Resident #1’s general health, safety, and physical and emotional well-being during the period of May 19, 2005, through July 18, 2005. Resident #3 132. Record review during the October 27, 2005, complaint survey of the Facility revealed that Resident #3 was admitted to the Facility on December 15, 2004. 133. Review of the Facility’s admission/discharge log revealed that Resident #3 expired on September 28, 2005. 134, In an interview conducted on or about October 26, 2005, at approximately 9:00 a.m., a family member of Resident #3 indicated that he/she had visited the resident on September 27, 2005, and that the resident had been complaining of headaches off and on for a week prior to expiring on September 28, 2005. He/she further indicated that a staff member called him on the morning of September 28, 2005, and informed him/her that Resident #3 had been found expired on the bathroom floor that moming. 135. The last entry in Resident #3’s ROL was dated September 20, 2005, and indicated that the resident was doing well, had gained six (6) pounds since admission to the Facility, and had engaged in walks on the paths around the facility, either with a walker or caregiver assistance. 136. In an interview conducted October 25, 2005, at approximately 3:15 p.m., the Administrator indicated that she was not present when Resident #3 was found expired in the Facility, but that the physician and 911 both were alerted when Resident #3 was found. 137. Review of Resident #3’s ROL revealed no entry or documentation regarding any observations made of or complaints made by the resident between September 21, 2005, and September 28, 2005. 138. Based upon the above, the Agency determined that Facility staff failed to perform their responsibilities, consistent with their qualifications, to observe, document observations, and/or report observations to the appropriate health care provider for Resident #3, in violation of Rule 58A-5.019(2)(b), Florida Administrative Code (2005), as evidenced by Facility staff's failure to document any type of observation concerning Resident #3’s general health, safety, and physical and emotional well-being during the period of September 21, 2005, and September 28, 2005. Resident #5 139. Review of Resident #5’s health assessment, dated September 24, 2004, revealed the resident had multiple diagnoses, including dementia. 140. . During an interview, the Administrator indicated that in early October 2005, Resident #5 had walked up to the front sidewalk of the F. acility property to watch the road construction. On such date, when the Administrator arrived at the Facility, the direct care staff members were unaware of Resident #5’s whereabouts. 141, The Administrator stated the direct care staff's lack of oversight regarding Resident #5 led to disciplinary action for those employees. 142. The Facility has no elopement policy and there was no documentation in Resident #5’s record regarding the wandering. 143. In an interview conducted on or about October 26, at approximately 10:30 a.m., the employee designated to be in charge of the Facility during the Administrator’s absence stated that he/she did not know what an elopement was. 144. Based upon the above, the Agency determined that Facility staff failed to perform their responsibilities, consistent with their qualifications, to observe, document observations, and/or report observations to the appropriate health care provider for Resident #4, in violation of Rule 58A-5.019(2)(b), Florida Administrative Code (2005), as evidenced by Facility staff's failure to observe Resident #5 during the morning of October 4, 2005, and/or failed to have a general awareness of Resident #5’s whereabouts on that same date, in violation of Rule 58A- 5.0182(1)(c), Florida Administrative Code (2005). 145. Based upon the above, the Agency determined that the Respondent failed to ensure that Facility staff perform their responsibilities, consistent with their qualifications, to observe residents, to document observations on the appropriate resident record, and to report the observations to the resident’s health care provider, in violation of Rule 58A-5 -0181(4)(b)(3), Florida Administrative Code (2005), and/or failed to have a general awareness of a resident’s whereabouts, in violation of Rule 58A-5.0182(1)(c), Florida Administrative Code (2005). 146. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security of the Facility residents. 147. The Agency cited the Respondent for a Class IT violation in accordance with Section 400.419(2)(b), Florida Statutes (2005). 148. The Agency provided a mandated correction date of November 27, 2005. 149. Respondent’s failure to ensure that Facility staff perform their responsibilities, consistent with their qualifications, to observe residents, to document observations on the appropriate resident record, and to report the observations to the resident’s health care provider, in violation of Rule 5 8A-5.0181(4)(b)(3), Florida Administrative Code (2005), and/or failure to have a general awareness of a resident’s whereabouts, in violation of Rule 58A-5 .0182(1)(c), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(b), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(b), Florida Statutes (2005). COUNT IX 150. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and One Hundred Five (105) through One Hundred Nineteen (119) as if fully recited herein. 151. Pursuant to Rule 58A-5.0185(7)(c), Florida Administrative Code (2005), if'a medication prescribed to an assisted living facility resident includes directions for use that are “as needed” or “as directed,” the health care provider shall be contacted and requested to provide revised instructions. For an “as needed” prescription, the circumstances under which it would be appropriate for the resident to request the medication and any limitations shall be specified; for example, “as needed for pain, not to exceed 4 tablets per day.” The revised instructions, including the date they were obtained from the health care provider and the signature of the staff who obtained them, shall be noted in the medication record, or a revised label shall be obtained from the pharmacist. 152. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”). 153. As aresult of record review and observation during the October 27, 2005, survey, the Agency determined that the Respondent failed to request revised instructions for medications prescribed “as needed.” In the alternative, even if the Respondent did obtain such revised instructions, the Respondent failed to update the medication record to reflect (1) the revised instructions, (2) the date such revised instructions were obtained, (3) the identity of the Facility staff who obtained the revised instructions, and/or failed to obtained a revised label from the pharmacist. Either such failure constitutes a violation of Rule S8A-5 .0185(7)(c), Florida Administrative Code (2005). 154. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security of the Facility residents. 155. The Agency cited the Respondent for a Class II violation in accordance with Section 400.419(2)(b), Florida Statutes (2005). 156. The Agency provided a mandated correction date of November 27, 2005. 157. Respondent’s failure to request revised instructions for medications prescribed “as needed,” or, in the alternative, failure to update the medication record to reflect (1) the revised instructions, (2) the date such revised instructions were obtained, (3) the identity of the Facility staff who obtained the revised instructions, and/or failure to obtained a revised label from the pharmacist, in violation of Rule 58A-5 -0185(7)(c), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(b), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(b), Florida Statutes (2005). COUNT X 158. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) and as if fully recited herein. 159. Pursuant to Rule 58A-5 -0182(2)(b), Florida Administrative Code (2005), an assisted living facility is required to provide care and services appropriate to the needs of residents accepted for admission to such facility. 160. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”). Resident #1 161. The Agency re-alleges and incorporates Paragraphs Thirteen (13) through Sixty- One (61) as if fully recited herein. 162. As aresult of record review and interview during the October 27, 2005, survey, 30 the Agency determined that the Respondent failed to provide care and services appropriate to the needs of Resident #1, in violation of Rule 58A-5.0182(2)(b), Florida Administrative Code (2005), as evidenced by the failure of Facility staff to: (1) appropriately care for and treat Resident #1’s decubitus ulcers, (2) provide services necessary to improve the condition of Resident #1’s decubitus ulcers, (3) arrange for the provision of appropriate services to care for and treat Resident #1°s decubitus ulcers, and/or (4) recognize the Facility’s failure to improve the condition of Resident #1’s decubitus ulcers and arrange for the timely transfer of such resident to a health care facility better equipped to provide appropriate care and services to Resident #1. Resident #4 163. The Agency re-alleges and incorporates Paragraphs One Hundred Five (105) through One Hundred Nineteen (119) as if fully recited herein. 164. Asaresult of record teview and interview during the October 27, 2005, survey, the Agency determined that the Respondent failed to provide care and services appropriate to the needs of Resident #4, in violation of Rule 58A-5.0182(2)(b), Florida Administrative Code (2005), as evidenced by the failure of Facility staff to: (1) obtain additional prescribing information for medications prescribed to Resident #4 to ensure that such resident received appropriate dosages under appropriate circumstances, and /or (2) continue providing prescribed medications until obtaining an order to discontinue medication from the appropriate health care professional. 165. Based upon the above, the Agency determined that the Respondent failed to provide care and services appropriate to the needs of residents accepted for admission to the Facility, in violation of Rule 58A-5.0182(2)(b), Florida Administrative Code (2005). 31 166. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security of the Facility residents. 167. The Agency cited the Respondent for a Class II violation in accordance with Section 400.419(2)(b), Florida Statutes (2005). 168. The Agency provided a mandated correction date of November 27, 2005. 169. Respondent’s failure to provide care and services appropriate to the needs of residents accepted for admission to the Facility, in violation of Rule 58A-5 .0182(2)(b), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(b), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(b), Florida Statutes (2005). COUNT XI 170. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully recited herein. 171. Pursuant to Rule 58A-5.0182(1)(d), Florida Administrative Code (2005), an assisted living facility is required to contact a resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager, if the resident exhibits a significant change. 172. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”). Resident #1 173. The Agency re-alleges and incorporates Paragraphs Thirteen (13) through Sixty- One (61) as if fully recited herein. 174, As a result of record review and interview during the October 27, 2005, survey, the Agency determined that the Respondent failed to contact Resident #1’s health care provider and/or other appropriate party such as the resident's family, guardian, health care surrogate, or case manager, if the resident exhibits a significant change, in violation of Rule 58A- 5.0182(1)(d), Florida Administrative Code (2005), as evidenced by the failure of Facility staff to: (1) notify Resident’s #1°s physician or other appropriate party concerning the development of a stage 3 decubitus ulcer to Resident #1’s right heel during the period of April 20, 2005, through May 13, 2005, and/or (2) notify Resident’s #1’s physician or other appropriate party concerning the changes in resident #1’s condition that resulted in that resident’s hospitalization on July 18, 2005. Resident #3 175. The Agency re-alleges and incorporates Paragraphs One Hundred Thirty-Two (132) through One Hundred Thirty-Seven (137) as if fully recited herein. 176. Asa result of record review and interview during the October 27, 2005, survey, the Agency determined that the Respondent failed to contact Resident #3’s health care provider and/or other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager, if the resident exhibits a significant change, in violation of Rule 58A- 33 5.0182(1)(d), Florida Administrative Code (2005), as evidenced by the failure of Facility staff to notify Resident #3’s physician concerning the headaches that occurred to Resident #3 in the week-long period preceding that resident’s death. 177. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security of the Facility residents, 178. The Agency cited the Respondent for a Class II violation in accordance with Section 400.41 9(2)(b), Florida Statutes (2005). 179. The Agency provided a mandated correction date of November 4, 2005. 180. Respondent’s failure to contact a resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager, if the resident exhibits a significant change, in violation of Rule 58A-5.0182(1 )(d), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(b), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(b), Florida Statutes (2005). COUNT XI 181. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully recited herein. 34 182. Pursuant to Rule 58A-5.0182(1)(e), Florida Administrative Code (2005), an assisted living facility is required to maintain a written record, updated as needed, of any significant changes in the resident’s normal appearance or state of health, any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services. 183. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”). Resident #1 184. The Agency re-alleges and incorporates Paragraphs Thirteen (13) through Sixty- One (61) as if fully recited herein. 185. As a result of record review and interview during the October 27, 2005, survey, the Agency determined that the Respondent failed to maintain a written record, updated as needed, of any significant changes in Resident #1’s normal appearance or state of health, any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services, in violation of Rule S8A-5.0182(1)(e), Florida Administrative Code (2005), as evidenced by Facility staffs failure to: (1) appropriately document observations concerning the staging of Resident #1’s decubitus ulcers, (2) document any treatments/services conceming Resident #1’s decubitus ulcers, and/or (3) document any type of observation concerning Resident #1’s general heaith, safety, and physical and emotional well-being during the period of May 19, 2005, through July 18, 2005, despite significant changes to such resident’s appearance and state of health during such time period. 35 Resident #3 186. The Agency re-alleges and incorporates Paragraphs One Hundred Thirty-Two (132) through One Hundred Thirty-Seven (137) as if fully recited herein. 187. Asa result of record review and interview during the October 27, 2005, survey, the Agency determined that the Respondent failed to maintain a written record, updated as needed, of any significant changes in Resident #3’s normal appearance or state of health, any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional Services, in violation of Rule 58A-5 -0182(1)(e), Florida Administrative Code (2005), as evidenced by Facility staff's failure to as evidenced by the failure of Facility staff to: qd) document the headaches suffered by Resident #3 during the period of September 21, 2005, and September 28, 2005, and (2) failure to maintain update, in any fashion, Resident #3’s written record during that time period. 188. Based upon the above, the Agency determined that the Respondent failed to maintain a written record, updated as needed, of any significant changes in Resident #3’s normal appearance or state of health, any illnesses which resulted in medical attention, major incidents, changes in the method of medication administration, or other changes which resulted in the provision of additional services, in violation of Rule 58A-5 -0182(1)(e), Florida Administrative Code (2005). 189. The Agency determined that this deficient practice was related to the operation and maintenance of the Facility or to the personal care of residents and directly threatened the physical or emotional health, safety, or security of the Facility residents. 36 190. The Agency cited the Respondent for a Class II violation in accordance with Section 400.419(2)(b), Florida Statutes (2005). 191. The Agency provided a mandated correction date of November 4, 2005. 192. Respondent’s failure to contact a resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager, if the resident exhibits a significant change, in violation of Rule S58A-5 0182(1)(d), Florida Administrative Code (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1000.00), pursuant to Section 400.419(2)(b), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of ONE THOUSAND AND NO/100 DOLLARS ($1,000.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(2)(b), Florida Statutes (2005). COUNT XII 193. The Agency re-alleges and incorporates Paragraphs One (1) through Five (5) as if fully recited herein. 194. Pursuant to Section 400.428(1)(a), Florida Statutes (2005), every resident of an assisted living facility has the ri ght to live in a safe and decent living environment, free from abuse and neglect. 195. Pursuant to Section 415 -1002(15), Florida Statutes (2005), “neglect" means the failure or omission on the part of the caregiver to provide the care, supervision, and services necessary to maintain the physical and mental health of the vulnerable adult, including, but not limited to, food, clothing, medicine, shelter, supervision, and medical services, that a prudent 37 person would consider essential for the well-being of a vulnerable adult. The term "neglect" also means the failure of a caregiver to make a reasonable effort to protect a vulnerable adult from abuse, neglect, or exploitation by others. "Neglect" is repeated conduct or a single incident of carelessness which produces or could reasonably be expected to result in serious physical or psychological injury or a substantial risk of death. 196. Pursuant to Section 415 .1002(26), Florida Statutes (2005), the term “vulnerable adult” means a person 18 years of age or older whose ability to perform the normal activities of daily living or to provide for his or her own Care or protection is impaired due to a mental, emotional, long-term physical, or developmental disability or dysfunctioning, or brain damage, or the infirmities of aging. 197. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Respondent’s assisted living facility (hereinafter “Facility”). Resident #1 198. The Agency re-alleges and incorporates Paragraphs Thirteen (13) through Sixty- One (61) as if fully recited herein. 199. As aresult of record review and interview during the October 27, 2005, survey, the Agency determined that the Respondent failed to provide to Resident #1 a safe and decent living environment, free from neglect, in violation of Section 400.428(1)(a), Florida Statutes (2005), as evidenced by the Administrator’s failure to: (1) appropriately care for Resident #1’s decubitus ulcers, (2) ensure that F: acility staff were appropriately trained to care for Resident #1’s decubitus ulcers, (3) continuously monitor Resident #1 for appropriateness of placement in the Facility, (4) recognize that Resident #1 was not receiving adequate care or treatment for 38 decubitus ulcers at the Facility, and (5) timely transfer such resident to a another type of health care facility where appropriate care could be properly rendered. Resident #4 200. The Agency re-alleges and incorporates Paragraphs One Hundred Five (105) through One Hundred Nineteen (119) as if fully recited herein. 201. As aresult of record review and interview during the October 27, 2005, survey, the Agency determined that the Respondent failed to provide to Resident #4 a safe and decent living environment, free from neglect, in violation of Section 400.428(1)(a), Florida Statutes (2005), as evidenced by the failure of Facility staff to: (1) obtain additional prescribing information for medications prescribed to Resident #4 to ensure that such resident received appropriate dosages under appropriate circumstances, and/or (2) continue providing prescribed medications until obtaining an order to discontinue medication from the appropriate health care professional. 202. Based upon the above, the Agency determined that the Respondent failed to provide the care, supervision, and services necessary to maintain the physical and mental health of Residents #1 and #4, vulnerable adults, including the supervision, care, and medical services that a prudent person would consider essential for the well-being of such residents. The Agency further determined that, with regards to Resident #1, the incidents of neglect and carelessness described above could reasonably be interpreted to have contributed to Resident #1’s demise. 203. Based upon the above, and upon the definition of “neglect” set forth in Section 415.1002(15), Florida Statutes (2005), the Agency determined that the Respondent neglected Residents #1 and #4. 39 204. Based on the above, the Agency determined that the Respondent failed to comply with all provisions of the Resident Bill of Rights, in violation of Section 400.428(1), Florida Statutes (2005). Specifically, the Agency determined that the Respondent failed to ensure that each Facility resident lived in a safe and decent living environment, free from abuse and neglect, in violation of Section 400.428(1), Florida Statutes (2005). 205. The Agency cited the Respondent for a Class I violation in accordance with Section 400.419(2)(a), Florida Statutes (2005). 206. The Agency provided a mandated correction date of November 4, 2005. 207. Respondent’s failure to ensure that each Facility resident lived in a safe and decent living environment, free from abuse and neglect, in violation of Section 400.428(1), Florida Statutes (2005), as set forth in this count, constitutes grounds for the imposition of an administrative fine in the amount of FIVE THOUSAND AND NO/100 DOLLARS ($5000.00), pursuant to Section 400.419(2)(a), Florida Statutes (2005). WHEREFORE, the Agency intends to impose an administrative fine in the amount of FIVE THOUSAND AND NO/100 DOLLARS ($5000.00), against Respondent, an assisted living facility in the State of F lorida, pursuant to Section 400.419(2)(a), Florida Statutes (2005). COUNT XIV 208. The Agency te-alleges and incorporates Paragraphs One (1) through Five (5), and the remainder of this Administrative Complaint as if fully set forth herein. 209, Pursuant to Section 400.419(10), Florida Statutes (2005), in addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one half of a facility’s biennial license and bed fee or $500, to cover the cost of conducting initial 40 complaint investigations that result in the finding of a violation that was the subject of the complaint or monitoring visits conducted under Section 400.428(3)(c), Florida Statues (2004), to verify the correction of the violations. 210. The Agency received a complaint alleging neglect of a resident of the Respondent’s assisted living facility (hereinafter “Facility”). 211. On or about October 25 through October 27, 2005, the Agency conducted a complaint survey (CCR #2005008918) of the Facility that resulted in violations that were the subject of the complaint to the Agency, including the neglect of a resident of the Facility. 212. Pursuant to Section 400.419(10), Florida Statues (2005), such a finding subjects the Respondent to a survey fee equal to the lesser of one half of the Respondent’s biennial license and bed fee or $500.00. 213, The Respondent’s biennial license and bed fee exceeds $1000. 214. Respondent is therefore subject to a complaint survey fee of FIVE HUNDRED AND NO/100 DOLLARS ($500.00), pursuant to Section 400.419(10), Florida Statutes (2008). WHEREFORE, the Agency intends to impose an additional survey fee of FIVE HUNDRED AND NO/100 DOLLARS ($500.00) against Respondent, an assisted living facility in the State of Florida, pursuant to Section 400.419(10), Florida Statutes (2005). LEE AEE GLE T. Mulligan Fla. Bar. No. 0676543 Senior Attorney Agency for Health Care Administration 525 Mirror Lake Drive North, Suite 330L St. Petersburg, Florida 33701 Respectfully submitted this / 3™ day of April, 2006. Respondent is notified that it has a ri ght to request an administrative hearing pursuant to Section 41 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights. 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 I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7004 2510 0005 4049 1949 on April _/37, 2006 to Abimbola Ogun, Owner/Administrator, Shady Oaks of Curlew, 1889 Curlew Road, Palm Harbor, FL 34683. ete fian Mulfi Copies furnished to: Abimbola Ogun Brian Mulligan. Owner/Administrator Agency for Health Care Admin. Shady Oaks of Curlew 525 Mirror Lake Drive, 330L 1889 Curlew Road St. Petersburg, Florida 33701 Palm Harbor, FL 34683 (Interoffice) (U.S. Certified Mail)

Docket for Case No: 06-002376