STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION ao pea | ay 5 a0 STATE OF FLORIDA, . om StS 7 << AGENCY FOR HEALTH CARE wii ADMINISTRATION, ~2 i Se gory a fee Petitioner, wo ao ¥. Case No. 2007005767 WESTWOOD MANOR Respondent. ADMINISTRATIVE COMPLAINT - COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration, (hereinafter “the Agency”), by and through the undersigned counsel, and files this administrative complaint against the Respondent, Westwood Manor (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2006), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine against an assisted living facility in the amount of ONE THOUSAND DOLLARS ($1,000.00) based upon one uncorrected class II violation. JURISDICTION AND VENUE Le The Court has jurisdiction over the subject matter pursuant to Sections 120,569 and 120.57, Florida Statutes (2006). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2006). 3. Venue lies pursuant to Florida Administrative Code Rule 28-106.207. PARTIES 4. The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable federal and state regulations, statutes and rules, governing assisted living facilities. Chapter 408, Part II, and Chapter 429, Part J, Florida Statutes (2006); Chapter 58A-5, Florida Administrative Code. The Agency may deny, revoke, or suspend any license issued to an assisted living facility, or impose an administrative fine in the manner provided in Chapter 120, Florida Statutes. Sections 408.813, 408.815, 429,14, Florida Statutes (2006). 5. The Respondent was issued a license by the Agency (License Number 8914) to operate a 30-bed assisted living facility located at 2339 Hoople Street, Fort Myers, Florida 33901, and was at all times material required to comply with the applicable federal and state Tegulations, statutes and rules governing assisted living facilities. : ) COUNT I The Respondent Failed To Maintain Resident Record Standards That Must Include Any Health Care Provider’s Orders For Medications, Nursing Services, Therapeutic Diets, Do Not Resuscitate Order, Or Other Services To Be Provided, Supervised, Or Implemented By The Facility That Require Health Care Provider’s Orders In Violation Of Rule 58A4-5.024(3)(c), Florida Administrative Code And Section 400.426(4) Florida Statutes (2006) 6. . The-Agency realleges and incorporates by reference paragraphs 1 through 5. 7. Pursuant to Florida law, the facility shall maintain the following written records in a form, place and system ordinarily employed in good business practice and accessible to Department of Elder Affairs and Agency staff. Resident records shall be maintained on the premises and include: Any health care provider’s orders for medications, nursing services, therapeutic diets, do not resuscitate order, or other services to be provided, supervised, or implemented by the facility that require a health care provider’s order. Rule 5 8A-5.024(3)(c), Florida Administrative Code (2006). nN 8. The Respondent’s deficient practice was related to the operation and maintenance of the facility or to the personal care of residents which indirectly or potentially threatens the physical or emotional health, safety, or security of the facility residents and constituted a class III deficiency as provided for in Subsection 429.19(2)(c), Florida Statutes (2006). 9. On or about June 21, 2006 the Agency conducted a Complaint Survey of Respondent's facility. 10. Based on record review and interview with facility staff, the facility failed to obtain. physicians orders to discontinue medications that were ordered on the admission health assessment (1823) form for one (1) of three (3) sampled residents, Resident number four (4). 11. A review of the record for Resident number four (4) reveals he/she was admitted to the facility on March 2, 2006 with diagnoses that include, but are not limited to, Anemia, Alcoholic Cirrhosis, and Chronic Hepatitis C. The resident also had a history of encephalopathy related to his liver disease. 12. The only health assessment form (1823) in the record was dated January 18, 2006 when the Resident had been discharged from a long-term care facility. The 1823 form lists multiple medications including Sorbitol 30ce to be given three (3) times a day (used to decrease ammonia levels in liver disease that can contribute to encephalopathy), Hemacyte plus (an iron preparation for treating anemia) once a day, and Celebrex 200mg (relieves pain of arthritis) once a day. 13. A review of the current Medication Observation Record for June, 2006 reveals the Resident is not receiving the Sorbitol, Hemacyte Plus, or Celebrex. A review of the Resident’s record reveals there are no physician orders to discontinue these medications. 14. During an interview on June 21, 2006 at approximately 11:15 a.m. the assistant Administrator stated that the Resident had not brought any of these medications with him/her upon admittance. The assistant Administrator also stated that the Resident often goes to a local health clinic where his/her medications are changed and the assistant Administrator does not usually get orders to discontinue or start medications. The assistant Administrator stated that she has tried to contact the health clinic but usually without success. The assistant Administrator confirmed that the health clinic is not the Resident’s attending physician and that she has not contacted the attending physician to clarify what medications the Resident should be receiving. 15. The Respondent’s deficiency constituted a class IIT violation. 16. | The Agency shall impose an administrative fine for a cited class III violation in an amount not less than $500 and not exceeding $1,000 for each violation. 17. The Respondent was given a mandatory correction date of July 21, 2006. 18. On or about August 29, 2006 through August 30, 2006 the Agency conducted a follow-up survey to a complaint investigation at Respondent’s facility. 19,‘ This is an uncorrected citation from the June 21, 2006 follow up survey. 20. Based on record review and interview with facility staff, the facility failed to obtain physicians orders to discontinue medications that were ordered on the admission health assessment (1823) form for one (1), Resident number nine (9) ,of four (4) sampled residents. 21. Resident number nine (9) was admitted on or about May 8, 2006. The resident's 1823 form had an order for Darvocet N100 1 tablet three times a day as needed. | 22. During a medication review on August 29, 2006 at about 4:00 p.m. a surveyor was provided with all of the resident's medications except for the Darvocet N100. The surveyor asked the owner where the Darvocet N100 was. The surveyor reviewed the 1823 form with the owner and showed the owner where the Darvocet N100 had been included on the May, 2006 Medication Observation Record but was not included on the June, 2006, July, 2006, or August, 2006 Medication Observation Record. 23, | There was no physician's order discontinuing the Darvocet N100. The owner called the resident's brother who is the legal guardian and inquired about the Darvocet N100. The owner stated the brother did not want his brother to receive the Darvocet N100 and had not provided the medication. ) 24. The owner was informed that a physicians’ order was needed to discontinue the medication. 25, The Respondent was given 4 mandatory correction date of September 30, 2006. 26, On or about November 15, 2006 through November 16, 2006 the Agency conducted a follow-up survey to a complaint investigation at Respondent’s facility. 27. This is an uncorrected class III citation from the June 21, 2006 and August 30, 2006 follow up surveys. . 28. Based on record review and interview with facility staff, the facility failed to obtain physicians’ orders for medications and medication changes for two (2), Residents number ten (10) and number eleven (11) of 4 sampled residents. 29. A review of the clinical record for Resident number ten (10) reveals she was . admitted to the facility on October 18, 2006. Further review of the record reveals an order for Darvocet N-100 to be given every eight (8) hours. The order is dated October 26, 2006. There is no order in the record to change this medication. Review of the Medication Observation Record reveals the resident is receiving Darvocet at 8:00 am. and 8:00 pm. The Medication Observation Record states the medication is to be given every eight (8) hours. - 30. During an interview on November 15, 2006 at approximately 3:00 p.m. the Assistant Administrator stated that the Advanced Registered Nurse Practitioner had changed the order to twice a day. After reviewing Resident number ten’s (10) record the Assistant Administrator confirmed there was no order in the record to change the Darvocet. She stated that she would call the Advanced Registered Nurse Practitioner and have an order faxed to the facility. A copy of the fax with an order sheet dated November 3, 2006 was received with an order for Darvocet to be changed to every twelve (12) hours. 31. During a medication review for Resident number eleven (11) on November 16, 2006 a Flovent inhaler was in the resident's medication drawer. The label on the Flovent directs that Resident number eleven (11) is to receive 2 puffs twice a day. When asked why the Flovent was not on the Medication Observation Record the Assistant Administrator stated, "It has to be there. He has been getting Flovent for a long time. "A review of the resident's clinical record revealed there is no physician's order for the Flovent. Also medication review reveals Resident number eleven (11) is receiving Zocor 20mg every day, Isosorbide MN 30mg every day and Synthroid 50mcg every day. No physician orders were found in the resident's chart for these medications. The Assistant Administrator stated that she would call the Advanced Registered Nurse Practitioner and get the orders. | 32, | When asked why there were no orders for the medications for Residents number ten (10) and number eleven (11) she stated, The Advanced Registered Nurse Practitioner calls the medications into the pharmacy and we usually get a faxed order. “We didn't get any on these." | ; 33. The Respondent was given a mandatory correction date of December 16, 2006. 34. On or about December 28, 2006 the Agency conducted a follow-up survey to a complaint investigation at Respondent’s facility. 35, This is an uncorrected class Ill citation from the June 21, 2006, August 30, 2006, and November 15, 2006 follow up surveys. 36. Based on a review of three (3) clinical records, three (3) Medication Observation Records, and interviews with clinical staff, the facility did not ensure up to date physician's - orders for medications were present in the record for Resident number ten (10). 37, A review of Resident number ten’s (10) Medication Observation Record revealed the resident was taking both Imodium and Colace (the Imodium is to treat diarrhea, and the Colace is to help prevent constipation by making the stool more soft) on a regular basis. The Imodium was being taken two (2) times a day, and the Colace was documented as being given one (1) time a day. The Imodium was started on December 30, 2006 for diarrhea. Throughout the month of December the Colace is documented as being given on a daily basis. 38. An interview with clinical staff at 1:45 p.m. on December 28, 2006, revealed. the Colace hasn't been given the past couple of days as she has an order to discontinue this medication. There was no order present in the record to discontinue this medication. 39, The Respondent was given a mandatory correction date of January 28, 2007, 40, On or about April 5, 2007 the Agency conducted its fifth revisit for this uncorrected Class IIT deficiency. | 41. This is an uncorrected citation from the Tune 21, 2006, August 30, 2006, November 15, 2006, and December 28, 2006 follow up surveys. 42. Based on a review of four (4) clinical records including Medication Observation Records, the facility did not ensure up-to-date physician's orders were present in the record for Resident number ten’s (10) nursing services and Resident number nineteen’s (19) medications. 43. A review of Resident number ten’s (10) record revealed an order written on March 10, 2007 for the resident to begin taking Bactrim DS (an antibiotic) based on lab results for a diagnosis of UTI (Urinary Tract Infection). A review of the record failed to show evidence of an order for nursing service to complete a UA (Urinalysis) on March 8, 2007, 44. A review of Resident number nineteen’s (19) record revealed an order dated “March 29, 2007 for "Triamcinolone cream to be applied to bilateral feet, twice a day”. A review of the resident's March, 2007 and April, 2007 Medical Observation Records revealed the cream has been applied to both the feet and arms without benefit of an order. A teview of the record also failed to show evidence this order had been clarified as to the exact strength of medication to be used or its placement. , . 45, The Respondent was given a mandatory correction date of May 5, 2007. 46. The failure to maintain resident record standards is in violation of the law. 47,... The Agency determined that this deficient practice was related to the personal care of the resident that indirectly or potentially threatened the health, safety, or security of the resident and cited Respondent for and uncorrected Class III deficiency. 48. The same constitutes.grounds for ‘an uncorrected class Ill deficiency as defined by law. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent, an assisted living facility in the State of Florida, in the amount of ONE THOUSAND DOLLARS ($1,000.00), pursuant to , Section. 429.19(2)(C), Florida Statutes (2006), . | CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief: 1. Make findings of fact and conclusions of law in favor of the Agency. ‘2. Impose an administrative fine against the Respondent in the total amount of ONE THOUSAND DOLLARS ($1,000.00). 3. Enter any other relief that this Court deems just and appropriate. Respectfully submitted this @&*~ day of October, 2007. wn. Andrea M. Lang, Senior Attorney Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 NOTICE TELE RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. IF THE RESPONDENT WANTS TO HIRE AN ATTORNEY, IT/MHE/SHE HAS THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS FORM. THE RESPONDENT IS FURTHER NOTIFIED If THE ELECTION OF RIGHTS FORM IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. ; THE ELECTION OF RIGHTS FORM SHALL BE MADE TO THE AGENCY FOR HEALTH CARE ADMINISTRATION AND DELIVERED TO: AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BUILDING 3, MAIL STOP 3, TALLAHASSEE, FL 32308; TELEPHONE (850) 922-5873. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form have been served to: Peter Kramer, Administrator, Westwood Manor, 2339 Hoople Street, Fort Myers, Florida 33901, by U.S. Certified Mail, Return Receipt No, 7006 2150 0004 5871 0620, and to: John F Gilroy Ill, P. A., Counsel for the Respondent, 1435 East Piedmont Drive, Suite 215, Tallahassee, Florida 32308, by U. S. Certified Mail, Return Receipt No. 7006 2150 0004 5871 0903 on this ge day of October, 2007. _ Andrea M. Lang, Senior a Long Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203 Copies furnished to: Peter Kramer Administrator Westwood Manor 2339 Hoople Street Fort Myers, Florida 33901 (U.S. Certified Mail) Andrea M. Lang, Senior Attorney Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) John F. Gilroy III, P.A. Counsel for Respondent 1435 East Piedmont Drive, Suite 215 Tallahassee, Florida 32308 (U. S. Mail) | Kriste J. Mennella Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (Interoffice Mail) ayy . gy “ m £3 | 2p “SENDER: (COMPLETE THIS SECTION. @ Complete Items 1; 2,'and 3, Also complete “* } Item 4 If Restricted Delivery is desired, \ i Print your,name, and address on the raverse / ” 86:that wé ban feturn the'card to you, . @ Attach this card to the back of the mailpiece, ; -) orn the front If space permits, 7) Avilla Adcressed to: Peter Kramer, Adin nisten Wert rved Manor 2337 Moople Sfreet fer Piya, Florida 33 fo) B, ‘Rbcelvad by ( Printad Nama) ©, Date of Delivery © D, Is delivery address different from Item 1? (1 Yes YES, enter delivery address betow: [No ‘| 3, Service Type O Certified Malt 0) Express Mail C1 Registered 1 Return Receipt for Merchandise , 1 Insured Mall ~=16.0.0, * | 4, Restricted Delivery? (Extra Fee) 1.2 Attila Number? ff ge ge : (> Mile Numba ceo 7006 2150 0004 Sa7u Obe0. _——— es PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

Docket for Case No: 07-005154