Jul 16 2007 3:00PM COMMUNITY OXYGEN INC 352 860 2811 (O71-DdUS STATE OF FLORIDA . 07 AGENCY FOR HEALTH CARE ADMINISTRATION‘ JUL STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, iia r£ . 7 ‘ GS Petitioner, ; Case No. 2007006224 vs. DOS OF CRYSTAL RIVER ALF, LLC, d/b/a CRYSTAL GEM ALF, Respondent. ADMINIS TIVE COMP. COMES NOW the Agency For Health Care Administration (hefeinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against DOS OF CRYSTAL RIVER ALF, LLC, d/b/a CRYSTAL GEM ‘ALF, (heres: er “Respondent” or “Respondent Facility”), pursuant to §§ 120.569, and 120.57, Fla. Stat. (2006), and alleges: ' NATURE OF THE ACTION ~ This is an action to impose an administrative fine in the amount of two thousand five bundred dollars ($2,500.00) based upon one cited State Class Il ia deficiency and one cited State Class I deficiency pursuant to §§ 429.19(2)(b) and (c), Fla. Stat. (2006)... . JURISDICTION AND VENUE 1, The Agency has jurisdiction pursuant to §§ 20.42, 120.60, 408.802, and Chapter 429, Part I, Fla. Stat. (2006). 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207, ; PARTIES The Agency is the regulatory authority responsible for licensure of assisted living Received Time Jul.18. 2:49PM . Jul 16 2007 ‘3:00PM COMMUNITY OXYGEN. INC 352 B60 2811 facilities and enforcement of all applicable federal regulations, state tes and rules governing assisted living facilities pursuant to the Chapter 429, Part I, Fla. Stat., and Chapter 58A-5 Fla. . Admin. Code. 4. _ Respondent operates a 70-bed assisted living facility located at 10845 West Gem Street, Crystal River, Florida 34428, and is licensed as an assisted living facility, license number 10687. 5. Respondent was at all times material to this complaint 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 in this count. . 7. Pursuant to Florida law, every facility shall 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 as required by Section 429.02(2), Fla. Stat. (2006). Fla. Admin. Code R. S8A-5. 019(1). 8. On February 28, 2006, the Agency conducted a survey of - Respondent Facility i m response to a complaint. pe 8.1. Based upon the review of records ob inferview, the Respondent’s administrator, who is by law responsible for the overall jprovision of care. for the residents, failed to ensure that two (2) of two (2) residents were: appropriate for admission to the facility. 8.2. Petitioner’s representative reviewed the Respondent’s records on F ebruary Received Time Jul.i6....2:49PM i Jul 16 2007 3:00PM COMMUNITY. OXYGEN INC 352 860 2811 28, 2006 and noted that resident number two (“Resident #2) tequired administration of medication and the monitoring of blood glucose levels. 8.3. . Resident #2 was not appropriate for pl since the Respondent Facility does not employ nurses or required for. medication administration and blood nt , the Respondent Facility er licensed personnel who are iglucase level checks. © The administrator is responsible for evaluating and assessing|a resident to be appropriate for the facility, but the administrator did not note that Resident #2 not appropriate for the © Respondent Facility. 8.4. - Petitioner’s representative reviewed the Respo! ~ 28, 2006, and noted that the health assessment of resi contained another facility name and that the address and 8.5... Petitioner’s representative interviewed th February 28, 2006, who indicated the following: nt’s records on February t number one (“Resident #1”) hone number were incorrect. ¢ Respondent's. administrator on 8.5.1. There are no licensed personnel on Responient’s staff to administer medication or monitor blood. glucose levels; 8.5.2. Resident #1 had resided at another assisted living facility with his/her spouse and just recently the spouse had been taken tojthe pital, 8.5.3. Resident #1 was discovered on Highway if 8.5.4, The other facility asked the Respondent resident in Respondent Facility’s secured area; 8.5.5. The administrator stated that Resident #1 few days. “ ig to find the spouse; ty if they would place the "hasni't been here that long, just a 8.5.6. Resident #1 was. listed on the Resident «Fei 's log as s beng admitted on Received Time Jul.16.. 2:49PM Jul 16 2007.3:00PM COMMUNITY OXYGEN INC a52 960 2811 January 13, 2006, approximately one month and.15 idaysiprior to the February 28, 2006, complaint survey. . . 8.6. The health assessment for Resident #1 did hot reflect that Resident #1 was appropriate for placement in the Respondent Facility in light the resident’s wandering , | ie of a secure - activity, there was no physician’s .indication that the reside: and¢ring behaviors. placement, and no annotations or record of the resident’s 8.7. There was no indication that the Respondent faqility took staffing or other measures to provide adequate care and monitoring for the .wandering behavior of Resident #1. 8.8. An administrator’s failure to ensure that adequate staff and care are available for residents’ needs can indirectly or potentially threaten the physical or emotional health, safety, or security of Facility Residents by not providing residents with the care that the residents need, when they need the care. ; 8.9. Respondent’s administrator failed to ensyre that adequate staff and care were available to meet resident needs, the same being in violation of law. 8,10. The Agency provided Respondent with a mandatory correction date of © March 28, 2006. . 9. During a survey conducted on June 30, 2006, L Agency determined that the Respondent had corrected the deficiency identified in the Februaty 28} 2006, survey. 10. On April 25 and 26, 2007, the Agency conducted ap; Appraisal Survey of the Respondent Facility. : . 10.1. Based on the Teview of records, interviews and pbservations the Respondent’s administrator, who is responsible for the overall provision of care for the _ Received Time Jul.16. 2:49PM _ Jul 16 2007.3: 00PM COMMUNITY OXYGEN INC. 3 residents, failed to ensure that one (1) of two (5) residents! to the Respondent Facility. 52 B60 2811 was Appropriate for admission 10.2, The Respondent Facility’s administrator i to ensure that a resident, Oo} “Resident #3,” was adequately supervised and that all Resident #3’s needs could be met in regard to Accuchecks of Resident #3's blood giu¢ose level and administration of insulin. 10.3: . - The-Respondent Facility does not have Limited Nursing Service licensure, ‘ _ nor does the Respondent Facility have licensed nurses or other licensed personnel on staff licensed to administer medication, including having no perform blood glucose level testing or to administer te injéctions. : 10.4. A review of Resident #3°s records at the 10.4.1. Resident #3 is diagnosed with “dounload diabetes, hypothyroidism, peripheral vascular disease, 10.4.2. Resident #3 resides in the locked memory 10.4.3. Resident #3’s medication orders state check Resident #3’s blood glucose level every Mo licerlsed personnel on staff to sporkient Facility reveal that: etic neuropathy, Type Tl wil yronary artery disease. it of the Respondent Facility. A Accucheck should be used to at 4:30 p.m., and that 34 units - of Lantus insulin should be administered subcutaneously every evening at bedtime. 105. The Agency representative observed Resident |#3 on April 25, 2007, at 7:30 p.m. in the presence of one of Respondent Facility’s emp yees, “Resident Assistant #3.” 10.5.1. Resident Assistant #3 did not know if Resident #3 could or could not self- administer Accucheck tests of Resident #3’s blood glucose level, and Resident Assistant #3 denied being present when any Accucheck testing of Resident #3 was. Recelved Time Jul.t6.. 2:49PM Jul 16 2007 3:01PM COMMUNITY OXYGEN INC 352 860 2811 p.7 performed. 10.5.2. The Agency representative requested that Resiflent Assistant #3 give to Resident #3 the Accucheck supplies and ‘that Resident ‘Assistant #3 request that Resident #3 self-administer the Accucheck testing, r ™ presence of the Agency representative. . 10.53. The Agency representative observed Resident Assistant #3 place the ~-Accucheck supplies in the hands of Resident #3 and request that Resident #3 self- administer the Aceucheck testing. 10.5.4. The Agency representative observed that upon eing given the Accucheck supplies, Resident #3 dropped the supplies into Resident #3’s lap and asked for what reason the Accucheck supplies had been given to odes 3. 10.5.5. At the request of the Agency representative, Resident #3 was again given the Accucheck testing supplies, and Resident #3 was again requested by Resident Assistant #3 to self-administer the Accucheck test, but Resident #3 was again unable to self-administer the Accucheck test. 10.5.6. Resident #3’s spouse was interviewed by the , ency representative on May 4, 2007, at 8:00 a.m., and the Agency represen whe told by Resident #3’s spouse that Resident #3 has not been able to ear self-administration of blood glucose level testing or the self-administration of insulin in many years. due to Resident #3’s confusion. 7 10.6. An Administrator’s failure to ensure that adequate staff and care are available for resident’s needs can indirectly or potentially) ‘threaten the physical or emotional health, safety, or security of Facility Residents|by n t providing residents with Received Time Jul.18. 2:49PM Jul. 16.2007 3:01PM COMMUNITY. OXYGEN INC _ 952 860 2811 the care that residents need, when they need the care, sud but not limited to the provision of services requiring licensure. 10.7. The Agency determined that this deficient Respondent’s administrator failed to ensure that adequate meet residents’ needs, which indirectly or potentially ope the physical or emotional health, safety or security of facility residents. ~ 10.8. The Agency provided a mandated soa 11. Because the Respondent Facility’s administrato 28, 2006, and again as of April 26, 2007, to ensure that oe "and care were available to meet residents’ needs, the April 26, 2007, violation consti practice was evidence that the staffjand. care were available to n date of May 26, 2007. had failed as of both February d 4 repeat violation, and the Agency cited the Respondent Facility for a State Class HI repeat violation in accord with § 429.12(2)(c), Fla. Stat. (2006). WHEREFORE, the Agency intends to impose an ah fine in the amount of five hundred dollars ($500.00) against Respondent Facility, an sistéd living facility in the State of Florida, pursuant to § 429.19(2)(c), Fla, Stat. (2006). . COUNT 12. The Agency re-alleges and incorporates paragraphs » through (5) and (10) as if fully set forth in this count. 13. Pursuant to Florida law, for facilities which provide medication administration, @ . staff member, who is licensed to administer medications, must |be available to administer medication in accordance with a health care provider’s order of Pp Code R. 58A-5.0185(4)(a). Medication administration includes, is not limited to, blood glucose testing and the administration of insulin injection. Fla, Admin. Code R. 58A- ue Received Time Jui.16. °2:49PM stiption label. Fla. Admin. Jul 16 2007 3:01PM COMMUNITY OXYGEN INC 352 860 2811 5.0185(4)(a) and (c); cf. § 429.256(4), Fla. Stat. (2006). Specifically excluded from the statutory definition of “assistance with self-administration” of medication is “[t}he preparation of syringes for injection or the administration of medications by any injectable route.” § 429.256(4)(b), F ia. Stat. (2006). Also specifically excluded from the definition of “agsistance with self- administration” of medication are “[m]edications ordered by the 1 hysiian or health care professional with prescriptive authority to be given *as needed,” \ the order is written with — specific parameters that preclude independent judgment on the part of the unlicensed person, and at the request of a competent resident.” §429.256(4)(b), Fla. =) (2006). 14. | On February 28, 2006, the Agency conducted a ef Respondent in response "to acomplaint. : 14. 1. "Based upon the review of records and i wel ‘the Respondent facility . failed to ensure that a licensed staff member was availabl¢ to provide medications to two (2) of three (3) residents who were identified as requiring medication administration. 14.2. . The Agency representative reviewed Resppndent ’s records for residents numbered one (“Resident #1”) and two (‘Resident #2") on Fetfruary 28, 2006, and noted the following: 14.2.1. The health assessment of Resident #1 indi ated|that the “Patient is severely impaired intellectually by dementia;” 14.2.2. The health assessment of Resident #2 indicated, that the resident required medication administration and monitoring of blood glucose levels. 143. The Agency’s representative interviewed the Respondent’s staff aide on February 28, 2006, who indicated that she does adminis dications to residents that are cognitively impaired. Received Tine Jul-18. 2:49PN Jul 16 2007 3:01PM COMMUNITY OXYGEN INC - : 352 860 2811 : p.10 “14.4, The Agency’s representative interviewed | ndent’s administrator on February 28, 2006, who stated as follows: : 14.4.1. That there are no licensed personnel on Respondent Facility’s staff to administer medication or monitor blood giucose levels] 14.4.2, Respondent’s administrator opined that aid¢s can administer Tylenol if — they have orders PRN (“as needed”) for a fever or ' 14.4.3. Respondent’s administrator opined that such “as needed” administration does not require the aide to make a judgment call; 7 14.4.4. The administrator and the Advanced Registered Nurse Practitioner felt | that the elderly are going to have pains and fever and they don't need to “...go and sit “in the Emergency Room (ER) for 6 hours and then be hie and sent back here.” - a 145. ‘The administration of medication and the monitoring of blood glucose levels require training and skills of licensed personnel and such activity being conducted. by individuals without the requisite training, including butinot Hmnited to the assessment ‘of patients needs for administration of “as need ” drugs, irectly threatens the physical or emotional health, safety, or security of the residents of the Respondent Facility. 14.6, The Respondent failed to provide licensed staff tp administer medication, the same being a violation of law. . 14.7. The Agency provided Respondent with a mer correction date of March 28, 2006. | 15. During.a survey conducted on June 30, 2006, the Agency determined that the Respondent Facility had corrected the deficiency identified in the February 28, 2006, survey. Received Time Jul.16.. 2:49PM Jul 16 2007. 3:02PM COMMUNITY OXYGEN. INC 352 860 2811 p-.11 16. Asset forth in paragraph 10 of this complaint, on pril 45-and 26, 2007, the Agency conducted an Appraisal Survey of the Respondent Facility. 16.1. Based on observation, tecord review and in ervie y, the Respondent Facility failed to ensure that a licensed staff member was availa le to provide mediation to Resident #3, who is one (1) of five (5) residents no all bf whom were identified . as requiring medication administration. . : 16.2. Record review and interviews revealed that the Respondent Facility does not have Limited Nursing Service licensure, nor does the Respondent Facility have staff licensed to administer medication. ) 16.3. : Failure of Respondent Facility to provide it ‘ela staff to administer insulin injection and to perform blood glucose level me diréctly threatens the physical ~ or emotional health, safety, or security of Resident #3, be¢ause without monitoring of — Resident #3’s blood glucose level Resident #3’s diabetes ae without corrective action being taken, and because absent both m mitoring and insulin injection Resident #3’s diabetes is untreated and life threatening. ‘ a 16.4. The Respondent failed to provide licensed) ath administer medication, the same being a violation of law. 16.5. The Agency determined that this deficient practice was related to the * personal care of the resident that threatened the health, safety, jor security of the Tesident and cited Respondent Facility for a State Class I deficiency. 16.6. The Agency provided Respondent with a jnanditory correction date of May 26, 2007. 17. Because the Respondent Facility has failed as “en ‘ebruary 28, 2006, and Received Time Jul.16. . 2:49PM Jul 16 2007 3:02PM COMMUNITY OXYGEN INC 352 860 2811. pele again as of April 26, 2007, to provide licensed staff to administer medication, this is a second violation for purposes of applicable law, including determination of thel appropriate fine. ; WHEREFORE, the Agency intends to impose an adminis! bake in the amount of L lorida, pursuant to § $2,000.00 against Respondent, an assisted living facility in the State of 429,19(2)(b), Fla. Stat. (2006). Respectfully submitted this | 2 hey of June 2007. es H. Harris ; Bar. No. 817775 Counsel for Petitioner | Agency for Health Care Administration 525 Mirror Lake Drive, 330) St. Petersburg, Florida 33701 727.552.1535 (office) 727.552.1440 (fax) 120.569, Florida Statutes. Specific options for administrative acti ‘set out in the attached Respondent is notified that it has a right to request an administrative hearing pursuant to Section Election of Rights. os bay dministration, and All requests for hearing shall be made to the Agency for Health Care. 727 Mahan Drive, Bldg delivered to Agency Clerk, Agency for Health Care Administration, 43,MS #3, Tallahassee, FL 32308;Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFTED THAT THE FAIL TO:-REQUEST A HEARING | WITHIN 21 DAYS OF RECEIPT QF THIS COMPLAINT W RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMP iT JHE ENTRY OF A FINAL ORDER BY THE.AGENCY. : : ; CERTIFICATE OF SERVICE [HEREBY CERTIFY that a true and correct copy of the foreping has been served by US. Certified Mail, Return Receipt No. 7005 1160 0002 2254 9006 oh June 27°} 2007 to AGI Registered Agents, Inc., 1200-Brickell Avenue, Suite 900, Miami, FL|33131 and by regular US. Mail to Laurene Holder, Administrator, Crystal Gem ALF, 10845 We t Gem St., Crystal River, FL 34428. ; xy

Docket for Case No: 07-003360