STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION TE OF FLORIDA, AGENCY FOR HEALTH -E ADMINISTRATION, Petitioner, OT . SY HY ERRA HEALTHCARE CORPORATION, . ALTERRA STERLING HOUSE OF VENICE, Case No. 2007010409 Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency), by and igh the undersigned counsel, and files this Administrative Complaint against ALTERRA .LTHCARE CORPORATION, d/b/a ALTERRA STERLING HOUSE OF VENICE ‘inafter Respondent), pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and es: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of one thousand five red dollars ($1,500.00), based upon three uncorrected cited State Class III deficiencies uant to §§ 429.19(2)(c), Florida Statutes (2007). JURISDICTION AND VENUE The Agency has jurisdiction pursuant to §§ 20.42, 120.60 and Chapters 408, Part II, and Part I, Florida Statutes (2007). Venue lies pursuant to Florida Administrative Code R. 28-106.207. PARTIES The Agency is the regulatory authority responsible for licensure of assisted living ities and enforcement of all applicable federal regulations, state statutes and rules governing ted living facilities pursuant to the Chapters 408, Part II, and 429, Part I, Florida Statutes, Chapter 58A-5, Florida Administrative Code. Respondent operates a 60-bed assisted living facility located at 1200 Avenida Del Circo, ice, Florida 34285, and is licensed as an assisted living facility, license number 9071. Respondent was at all times material hereto a licensed facility under the licensing ority of the Agency, and was required to comply with all applicable rules and statutes. COUNT I The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set | herein. That pursuant to Florida law, medication which has been discontinued but which has not red shall be returned to the resident or the resident’s representative, as appropriate, or may sntrally stored by the facility for future resident use by the resident at the resident’s request. ntrally stored by the facility, it shall be stored separately from medication in current use, and rea in which it is stored shall be marked “discontinued medication.” Such medication may sused if re-prescribed by the resident’s health care provider. R. 58A-5.0185(6)(c), Florida hinistrative Code. That on June 7, 2007, the Agency conducted a Biennial Survey in conjunction with the ited Nursing Services (LNS) and Extended Congregate Care (ECC) surveys of the yondent facility. That based upon observation, the review of records, and interview, Respondent failed to rate discontinued medications from currently used medications for one (1) of four (4) pled residents, the same being contrary to law. That the Petitioner’s representative observed the medications Ativan 0.5 mg 1/2 tab q4h 10uth as needed for agitation received from the pharmacy on May 27, 2007 and Lortab 5/500 | tablet by mouth every 8 hours as needed for pain received from the pharmacy on May 16, /, were found in the medication drawer for resident number four (4) during a review of ications on June 7, 2007 at 11:45 a.m. That the Petitioner’s representative reviewed Respondent’s records regarding resident ber four (4) and noted that the resident’s physician had discontinued use of the Ativan and ab for the resident. That the Petitioner’s representative interviewed Respondent’s Health Care Coordinator ng the survey who indicated and acknowledged that the discontinued medications of Ativan Lortab should not be stored in the drawer with the current medications for resident number (4). That the above reflects Respondent’s failure to ensure that discontinued medications are :d separately from current medications and or returned to the resident's representative or rally stored for future use by the resident, the same being contrary to law. That the Agency determined that this deficient practice was related to the personal care of esident that indirectly or potentially threatened the health, safety, or security of the resident cited Respondent for a State Class II deficiency. That the Agency provided Respondent with a mandatory correction date of July 7, 2007. That on August 28, 2007 the Agency conducted a revisit to the Biennial Survey in unction with the Limited Nursing Services (LNS) and Extended Congregate Care (ECC) eys of the Respondent facility. That based upon observation, the review of records, and interview, Respondent failed to rate discontinued medications from currently used medications for one (1) of four (4) pled residents, the same being contrary to law. That on August 28, 2007 the Petitioner’s representative observed the following ications in the medication drawer for resident number eleven (11): a. Tylenol 500mg Extra Strength take 1 by mouth every 6 hours as needed for pain for 5 days and then discontinue, and Compazine 10mg 1/2 tab by mouth every 12 hours as needed for nausea/vomiting for 5 days and then discontinue, both medications having been received from the pharmacy on September 22, 2006; b. Combivent inhaler 2 puffs every 6 hours as needed for cough/dyspnea was received from the pharmacy on November 8, 2006. That the Petitioner’s representative reviewed the Respondent’s records for resident ber eleven (11) on August 28, 2007 and noted as follows: a. That the September 2006 medication observation record reflected that the above referenced Tylenol and Compazine were recorded as a stop date of September 27, 2006; b. That the physician’s order for the Tylenol and Compazine dated September 22, 2006 directed that the medications be discontinued in five (5) days; c. That the July 2007 medication observation record reflected that the above referenced Combivent were recorded as a stop date of July 24, 2007; d. That the physician’s order for the Combient dated July 24, 2007 directed that the medication be discontinued. That the Petitioner’s representative interviewed Respondent’s Health Care Coordinator ng the survey who indicated and acknowledged that the discontinued medications of Tylenol, ipazine, and Combient should not be stored in the drawer with the current medications for lent number eleven (11). That the above reflects Respondent’s failure to ensure that discontinued medications are -d separately from current medications and or returned to the resident's representative or rally stored for future use by the resident, the same being contrary to law. That the Agency determined that this deficient practice was related to the personal care of esident that indirectly or potentially threatened the health, safety, or security of the resident cited Respondent for an uncorrected State Class III deficiency. That the Agency provided Respondent with a mandatory correction date of September 007. That the same constitutes an uncorrected deficiency as defined by law. WHEREFORE, the Agency intends to impose an administrative fine in the amount of ).00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 19(2)(c), Florida Statutes (2007). COUNT II The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set herein. That pursuant to Florida law, an assisted living facility shall provide care and services priate to the needs of residents accepted for admission to the facility including, but not ted to, daily observation of the resident and awareness of the general health, safety, and sical and emotional well-being of the resident, the maintenance of a written record, updated ceeded, of any significant changes in the resident’s normal appearance or state of health and illnesses which resulted in medical attention, and the maintenance of nursing progress notes. ida Administrative Code R. 58A-5.0182. That on June 7, 2007, the Agency conducted a Biennial Survey in conjunction with the ited Nursing Services (LNS) and Extended Congregate Care (ECC) surveys of the ondent facility. That based upon the review of records, Respondent failed to provide the appropriate care services to meet the needs of the residents for one (1) of four (4) sampled residents in is re to conduct ordered tests as required by the resident’s health care provider, the same being rary to law. That the petitioner’s representative reviewed Respondent’s records regarding resident ber four (4) during the survey and noted the following: a. That the resident was admitted to the facility on May 2, 2007; b. That the medical record documented that on May 30, 2007 the resident’s advanced registered practical nurse ordered the following: "Obtain B/P, P, R, Pulse ox this afternoon when [the resident is] agitated;" c. That the resident log for May 30, 2007 documented at 2:00 p.m. that the resident became agitated; d. That records are devoid of any indication that Respondent obtained the blood pressure, pulse, respiration and pulse oximetry (B/P, P, R, Pulse ox) as ordered by the resident’s health care provider. ordered. The facility failed to provide the appropriate care as per contract to meet the needs and services of the resident. That the above reflects the Respondent’s failure to provide care and services appropriate -sident number four (4) in Respondent's failure to follow the health care provider’s orders to in certain identified health indicators of the resident when the resident experienced an ode of agitation, the same being contrary to law. That the Agency determined that this deficient practice was related to the personal care of esident that indirectly or potentially threatened the health, safety, or security of the resident cited Respondent for a State Class III deficiency. That the Agency provided Respondent with a mandatory correction date of July 7, 2007. That on August 28, 2007 the Agency conducted a revisit to the Biennial Survey in unction with the Limited Nursing Services (LNS) and Extended Congregate Care (ECC) eys of the Respondent facility. That based upon the review of records, Respondent record review, the facility failed to ‘ide the appropriate care and services to meet the needs of the residents for one (1) of four (4) lents reviewed in its failure to ensure the conduct of health care provider ordered tests for a lent, the same being contrary to law. That the Petitioner’s representative reviewed Respondent’s records regarding resident ber eight (8) during the survey and noted the following: a. That the resident’s health care provider ordered, on July 27, 2007 a "Fecal occult Blood K3;" b. That the resident’s health care provider ordered on July 31, 2007 "Guaics X3;” c. That the resident’s medication observation record (MOR) reflected that a single fecal sample had been obtained on August 6, 2007; d. That the results of that test were on the chart and dated August 7, 2007; ¢. That absent from the Respondent’s records was any indication that the second and third ordered samples were obtained from the resident, were tested, or results reported as Ordered. That the above reflects the Respondent’s failure to provide care and services appropriate sident number eight (8) in Respondent’s failure to follow the health care provider’s orders to in certain samples and ensure testing thereof for the resident three (3) times, the same being rary to law. That the Agency determined that this deficient practice was related to the personal care of esident that indirectly or potentially threatened the health, safety, or security of the resident cited Respondent for an uncorrected State Class IT] deficiency. That the Agency provided Respondent with a mandatory correction date of September 007. That the same constitutes an uncorrected deficiency as defined by law. WHEREFORE, the Agency intends to impose an administrative fine in the amount of .00 against Respondent, an assisted living facility in the State of Florida, pursuant to § 19(2)(c), Florida Statutes (2007). COUNT I The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set herein. That pursuant to Florida law, the administrator or owner of a facility must maintain a mnel record for each staff member. Section 429.275 Florida Statutes (2006). Said records be maintained by the facility accessible to department and agency staff, and must contain, pplicable, inter alia, documentation of compliance with all staff training required by Rule -5.0191, F.A.C. Florida Administrative Code R. S8A-5.024(2)(a)(1), Florida Administrative eR. 58A-5.0191(11). All facility employees must complete biennially, a continuing ation course on HIV and AIDS. New facility staff must obtain an initial training on S/HIV within thirty days of employment, unless the new staff person previously completed nitial training and has maintained the biennial continuing education training. Florida inistrative Code R. 58A-5.0191(3). That on June 7, 2007, the Agency conducted a Biennial Survey in conjunction with the ited Nursing Services (LNS) and Extended Congregate Care (ECC) surveys of the yondent facility. That based upon the review of records and interview, Respondent failed to ensure that or ide documentation that all staff completed a continuing education course on HIV and AIDS biennial basis for one (1) of six (6) employee records reviewed, the same being contrary to That the Petitioner’s representative reviewed Respondent's personnel record for oyee number three (3) during the survey and noted as follows: a. That the employee had been employed since October 25, 2004, in excess of two (2) years; b. That there was no documentation in the personnel record that the employee had completed continuing education for HIV and AIDS within the last 730 days; c. That there was no documentation prior to June 6, 2007 in the file that she had completed previous continuing education on HIV and AIDS. That the Petitioner’s representative interviewed Respondent’s executive director during survey who confirmed there was no documentation in the personnel file of employee number ¢ (3) reflecting the completion of continuing education for HIV and AIDS within the last 730 That the Respondent’s administrator provided to the Petitioner’s representative a copy of nline test dated June 6, 2007 from employee number three (3), however there were no test Its or certificate of completion available from the employee reflecting that the test was ed or the course completed as required. That the failure to ensure that mandated biennial training is timely completed and or the re to maintain documentation of the same in personnel records is in violation of law. That the Agency determined that this deficient practice was related to the personal care of esident that indirectly or potentially threatened the health, safety, or security of the resident ited Respondent for a State Class III deficiency. That the Agency provided Respondent with a mandatory correction date of July 7, 2007. That on August 28, 2007 the Agency conducted a revisit to the Biennial Survey in inction with the Limited Nursing Services (LNS) and Extended Congregate Care (ECC) ys of the Respondent facility. That based upon the review of records and interview, Respondent failed to ensure that or de documentation that all staff completed a continuing education course on HIV and AIDS n thirty (30) days of employment for one (1) of four (4) employee records reviewed, the being contrary to law. That the Petitioner’s representative reviewed Respondent’s personnel record for oyee number two (2) during the survey and noted as follows; a. That the employee was hired on April 25, 2007; b. That the employee completed the required training for all employees, including initial HIV/AIDS training, on August 28, 2007. That employee number two (2) had not completed required training within thirty (30) ; of employment as required by law, the same ultimately being completed four (4) months “employment. That the Petitioner’s representative interviewed Respondent’s administrator during the ey who confirmed that the date on the training certificate for employee number two ( 2) was d August 28, 2007, a date far in excess of the thirty (30) day time period after employment 1g which such training must be completed. That the failure to ensure that mandated training is timely completed and or the failure to tain documentation of the same in personnel records is in violation of law. That the Agency determined that this deficient practice was related to the personal care of esident that indirectly or potentially threatened the health, safety, or security of the resident ited Respondent for an uncorrected State Class III deficiency. That the Agency provided Respondent with a mandatory correction date of September 007. That the same constitutes an uncorrected deficiency as defined by law. WHEREFORE, the Agency intends to impose an administrative fine in the amount of .00 against Respondent, an assisted living facility in the State of Florida, pursuant to § '9(2)(c), Florida Statutes (2007). Respectfully submitted yi ( day of November, 2007. jy —— Thomas J. Walsh II Fla. Bar. No. 566365 . Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1525 pondent is notified that it has a right to request an administrative hearing pursuant to Section 569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney lis matter. Specific options for administrative action are set out in the attached Election of ats. requests for hearing shall be made to the Agency for Health Care Administration and vered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, z #3, MS #3, Tallahassee, Florida 32308. Telephone (850) 922-5873. ;PONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING ‘HIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN MISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A AL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by Certified Mail, Return Receipt No. 7007 0220 0001 1589 2761 on November _/_, 2007 to: -orporation System, Registered Agent for Alterra Sterling House of Venice, 1200 South Island Road, Plantation, Florida 33324, and by U.S. Mail to Matthew H. Glass, inistrator, Alterra Sterling House of Venice, 1200 Avenida Del Circo, Venice, Florida 35, 7 ita jj 4 Thondas J. Walsh IL Senior Attorney vies furnished to: thew H. Glass, Administrator rra Sterling House of Venice ) Avenida Del Circo ice, Florida 34285 CT Corporation System Registered Agent for Alterra Sterling House of Venice 1200 South Pine Island Road . Mail) Plantation, Florida 33324 (U.S. Certified Mail) te Mennella/David Day Thomas J. Walsh, II 1 Office Manager Agency for Health Care Admin. » Victoria Ave., Room 340 Ayers, Florida 33901-3884 . Mail) 525 Mirror Lake Drive, 330G St. Petersburg, Florida 33701 (Interoffice)

Docket for Case No: 07-005429