Certified Mail Receipt O 6-0 (70 (7004 2890 0000Y5527 2623). “aay Ss, é ‘2 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA NO.: 2007012639 VS. CASO, INC. d/b/a PARADISE MANOR II, Respondent. aaa a8 _/ ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION ("AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Caso, Inc. d/b/a Paradise Manor II (hereinafter “Paradise Manor IL”), pursuant to Section 120.569, and 120.57, Fla. Stat. (2007), alleges: NATURE OF THE ACTION 1. This is an action to impose five (5) administrative fines in the amount of Seven Thousand Five Hundred Dollars ($7,500.00), against Paradise Manor II for four (4) uncorrected class III deficiencies and one (1) uncorrected class Il deficiencies, pursuant to Sections 429.19(2\(b), 429.19(2)(c), Fla. Stat. (2007) and Rules 58A-5.0185(1)(a), 58A- 5.0185(5)(h), 58A-5.0185(7)(d), 58A4-5.0185(7f), and 58A-5.0182, Fla. Admin. Code (2007). JURISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to 429, Part I and Sections 120.569 and 120.57, Pla. Stat. (2007). . 3. Venue lies in Volusia County, Port Orange, Florida, pursuant to Section 120.57 Fla. Stat. (2007); Rule 584-5, Fla. Admin. Code (2007) and Section 28.106.207, Fla. Stat. (2007). PARTIES 4. AHCA, is the. regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 429, Part I, Fla. Stat. and Rules 584-5, Fla. Admin. Code (2007). 5. Paradise Manor II is a for-profit corporation, whose 6-bed assisted living facility is located at 435 GreenLeaf Square, Port Orange, Florida 32127. Paradise Manor Il is licensed as an assisted living facility license # AL9904; certificate number #21283, effective September 1, 2006 through August 31, 2008. Paradise Manor II was at all times material hereto, licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNT I PARADISE MANOR II FAILED TO ASSESS A RESIDENT’S ABILITY TO SELF- ADMINISTER MEDICATIONS FOR 1 OF 5 RESIDENTS (RESIDENT #3). THIS FAILURE MAY LEAD TO RESIDENTS RECEIVING THE WRONG DOSE OF MEDICATION. THIS WAS PREVIOUSLY CITED ON JULY 3, 2007. STATE TAG A601-MEDICATION STANDARDS Section 429.19(2)(c), Fla. Stat. (2007) VIOLATIONS; IMPOSITION OF . ADMINISTRATIVE FINES; GROUNDS Rule 58A-5.0185(1)(a), Fla. Admin. Code (2007) MEDICATION PRACTICES 6. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about September 26, 2007, AHCA conducted a follow-up monitoring visit at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a. On or-about July 3, 2007, Paradise Manor II failed to assess a resident’s ability to selfadminister medications for 1 of 7 residents (Resident #3). This failure may lead to residents receiving the wrong dose of medication. b. During a follow-up survey on or about September 26, 2007, Paradise Manor HI failed to assess a resident’s ability to selfadminister medications for 1 of 5 residents (Resident #3). This failure may lead to residents receiving the wrong dose of medication. This was previously cited on July 3, 2007. The Findings include: While reviewing Resident #3's September 2007 Medication Observation Record (MOR), Albuterol was ordered three times a day as needed for shortness of breath. Nonvlicensed facility staff was signing that the resident was receiving assistance with this medication. The MOR did not indicate that the resident was self-administering the medication. The Administrator on 9-26-07 at 8:50 am. confirmed this, The resident in an interview on 9-26-07 at 11 a.m. stated that he can do the nebulizer treatment for him/herself, but sometimes staff does it for him/her. The tesident's health assessment (Form 1823) signed by a physician on 5-18-07 revealed that the resident did need help with medication administration. The clinical record did not reveal that the resident was able to selfadminister his/her medication nor was there licensed staff to administer it. Class HI Correction Date: September 29, 2007 (Immediate) 8. The regulatory provisions of the Fla. Stat. (2007), that are pertinent to this alleged violation read as follows: 429.19 Violations; imposition of administrative fines; grounds. ~ (2)(c) Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class I or class II violations. The agency shall impose an administrative fine for a cited class IT] violation in an amount not less than $500 and not exceeding $1,000 for each violation. A citation for a class IIL violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. ~ ko 464.003 Definitions- (3)(a)(2) Practice of professional nursing" means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: 2. The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments. 58A-5.0185 Medication Practices. (1)(a) Residents who are capable of self-administering their medications without assistance shall be encouraged and allowed to do so. * OK OF 9. The violation alleged herein constitutes an uncorrected class III deficiency, and warrants a fine of $500.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $500.00 COUNT I PARADISE MANOR II FAILED TO MAINTAIN A DAILY MEDICATION OBSERVATION RECORD (MOR) IN SEPTEMBER 2007 FOR 4 OF 5 SAMPLED RESIDENTS (RESIDENT #1, #2 #3, AND #5). THIS COULD CAUSE SERIOUS MEDICATION ERRORS FOR THESE RESIDENTS AND COULD BE DETRIMENTAL TO THE RESIDENTS’ HEALTH STATUS. THIS WAS PREVIOUSLY CITED ON JULY 3, 2007. STATE TAG A615-MEDICATION STANDARDS Section 429.19(2)(c), Fla. Stat. (2007) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Rule 58A-5.0185(5}(b), Fla. Admin. Code (2007) MEDICATION PRACTICES 10. AHCA te-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. ll. On or about September 26, 2007, AHCA conducted a follow-up monitoring visit at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a.) On or about July 3, 2007, Paradise Manor II failed to maintain a daily medication observation record (MOR) for July 2007 for 4 of 7 residents (Resident #3, #4, #6, #7, and #2). This could cause serious medication errors for these residents and could be detrimental to the residents’ health status. This was previously cited on May 2, 2007. b.) During a follow-up survey on or about September 26, 2007, Paradise Manor Il failed to maintain a daily medication observation record (MOR) in September 2007 for 4 of 5 sampled residents (Resident 1, #2, #3, and #5). This could cause serious medication errors for these residents and could be detrimental to the residents’ health status. This was previously cited on July 3, 2007. The Findings include: 1. While observing unlicensed staff assist with medication assistance on 9-26-07 at 8:50 a.m., Resident #3's MOR did not have staff initials from the 231d to the 25th of September for all medications. The staff member stated on 9-26-07 at 8:50 a.m. that she did not sign for the medication because she had swelling in her hand and could not do so. 2. Resident #5's MOR had Metoclopramide signed off on 9-26-07 when in fact there was no medication available in his/her drawer to give to the resident. The staff member on 9-26-07 at 9:15 a.m. indicated that she signed it by mistake. The MOR on the 25th of September had not been signed that it was given to the resident. This same staff member stated that she did not sign this one as well due to her hand. 3. Resident #2 had a medication label of Aspirin 325 mg one a day. It was signed off that it was given twice a day September 1 through the 4th of 2007. The staff member who signed the MOR did not know why he signed it twice on those days. Resident #2 had three eye drops, Predforte, Brimononidine, and Zymar ordered daily and staff stopped signing for the medication after the 11th of September. The Administrator stated on 9-26-07 at 9:30 am. that one of the eye drops was discontinued, but confirmed that the MOR did not reveal that. 4. Resident #1 had a medication, Metoprolol 25 mg, 1/2 tab daily in his/her medication drawer. This medication was not on the September 2007 MOR. The Administrator on 9-26-07 at 9:48 a.m. confirmed. that the resident should be receiving this medication, but it was left off the MOR by the pharmacy. 5. Residents #2 and #1 also did not have the MORs signed for all medications from the 23rd to the 25th of September with the same staff member stating her swollen hand prevented her. Class III Correction Date: 9/29/07 (Immediate) 12. The regulatory provisions of the Fla. Stat. (2007), that are pertinent to this alleged violation read as follows: 429.19 Violations; imposition of administrative fines; grounds. ~ (2)(c} Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class I or class Il violations. 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, A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. ~ ek * 58A-5.0185 Medication Practices. (5)(b) The facility shall maintain a daily medication observation record (MOR) for each resident who receives assistance with selfadministration of medications or medication administration. A MOR must include the name of the resident and any known allergies the resident may have; the name of the resident’s health care provider, the health care provider’s telephone number; the name, strength, and directions for use of each medication; and a chart for recording each time the medication is taken, any missed dosages, refusals to take medication as prescribed, or medication errors. The MOR must be immediately updated each time the medication is offered or administered. * * * 13. The violation alleged herein constitutes an uncorrected class III deficiency, and warrants a fine of $1,000.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $1,000.00 COUNT Ill PARADISE MANOR II FAILED TO OBTAIN NEW PHYSICIAN ORDERS FOR CHANGES IN MEDICATIONS FOR 1 OF 5 SAMPLED RESIDENTS. THIS FAILURE COULD LEAD TO A MEDICATION ERROR AND COULD BE DETRIMENTAL TO THE RESIDENT’S HEALTH STATUS. THIS WAS PREVIOUSLY CITED ON JULY 3, 2007. STATE TAG 4629-MEDICATION STANDARDS Section 429.19(2)(c), Fla. Stat. (2007) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Rule 58A-5.0185(7)(d), Fla. Admin. Code (2007) MEDICATION PRACTICES ~ 14. AHICA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 15. On or about September 26, 2007, AHCA conducted a follow-up monitoring visit at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a.) On or about July 3, 2007, Paradise Manor I] failed to obtain a new physician order for a change in Warfarin (Coumadin) directors for use for 1 of 7 residents (Resident #4). This failure could lead to a medication error and could be detrimental to the resident’s health status. b) During a followup survey on or about July 3, 2007, Paradise Manor Il failed to obtain new physician orders for changes in medications for 1 of 5 sampled residents. This failure could lead to a medication error and could be detrimental to the -resident’s health status. This was previously cited on July 3, 2007. The Findings include: While reviewing Resident #2's medication observation record (MOR) for September 2007, three eye drops were no longer being signed by staff as being given after the 11th of September. The Administrator on 9-26-07 at 9:30 a.m. stated that one of the eye drops, Brimonidine was no longer to be given to the resident and wrote "D/C'd" on the current MOR. She could not produce the physician order that this medication was discontinued. Resident #2 also had Procrit ordered one injection every two weeks listed on the September 2007 MORs. The last injection was signed on the 7th of September. The next dose should have been given on the 22nd of September, but the MOR did not reveal this. The Administrator on 9-26-07 at 10:40 a.m. stated that the medication was put on hold and that is why she did not give it. The Administrator could not produce the physician order to hold this medication. Class III Correction Date: 9/29/07 (Immediate) 16. . The regulatory provisions of the Fla. Stat. (2007), that are pertinent to this alleged violation read as follows: 429.19 Violations; imposition of administrative fines; grounds. ~ (2c) Class "III" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class | ot class II violations. 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. A citation for a class I1] violation must specify the time within which the violation is required to be corrected. If a class ITI violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. 58A-5.0185 Medication Practices. (7d) Any change in directions for use of a medication for which the facility is providing assistance with self-administration or administering medication must be accompanied by a written medication order issued and signed by the resident’s health care provider, or a faxed copy of such order. The new directions shall promptly be recorded in the resident’s medication observation record. The facility may then place an “alert” label on the medication container which directs staff to examine the revised directions for use in the MOR, or obtain a revised label from the pharmacist. 17. The violation alleged herein constitutes an uncorrected class II] deficiency, and warrants a fine of $500.00. WHEREFORE, AHCA demands the following relief: L. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $500.00 COUNT IV PARADISE MANOR II FAILED TO REFILL MEDICATIONS IN A TIMELY MANNER FOR 1 OF 5 SAMPLED RESIDENTS. THIS WAS PREVIOUSLY CITED ON JULY 3, 2007. STATE TAG A631-MEDICATION STANDARDS Section 429.19(2)(c), Fla. Stat. (2007) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Rule 58A-5.0185(7)(f), Fla. Admin. Code (2007) MEDICATION PRACTICES 18. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 19. On or about September 26, 2007, AHCA conducted a follow-up monitoring visit at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a.) On or about July 3, 2007, Paradise Manor II failed to refill medications in a timely manner for 3 of 7 (Residents #4, #3, #1) residents and obtain medications for Resident #7 who was admitted the previous day. b.) During a follow-up survey on or about September 26, 2007, Paradise Manor Tl failed to refill medications in a timely manner for 1 of 5 sampled residents. This was previously cited on July 3, 2007. The Findings include: 1. Resident #5 had Metoclopramide 10 mg ordered each day per the September 2007 MOR. On 9-26-07 at 9:15 am. staff was assisting with medication administration to Resident #5, but did not have this medication available to do so. The staff member on 9-26-07 at 8:50 a.m. confirmed that this medication was not available. It was ordered over the weekend and should have been delivered. Class [il Correction Date: 9/29/07 (Immediate) 10 20. The regulatory provisions of the Fla. Stat. (2007), that are pertinent to this alleged violation read as follows: 429.19 Violations; imposition of administrative fines; grounds. ~ (2)(c) Class "IH" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents, other than class I or class I violations. 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. A citation for a class III violation must specify the time within which the violation is required to be corrected. If a class III violation is corrected within the time specified, no fine may be imposed, unless it is a repeated offense. a ed 58A-5.0185 Medication Practices. (7)(f) The facility shall make every reasonable effort to ensure that prescriptions for residents who receive assistance with self-administration of medication or medication administration are filled or refilled in a timely manner. +k * 21. The violation alleged herein constitutes an uncorrected class III deficiency, and warrants a fine of $500.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $500.00 COUNT V PARADISE MANOR II FAILED TO PROVIDE PHYSICIAN MEDICATIONS AND TREATMENTS ORDERS TO CARE FOR 2 OF 5 SAMPLED RESIDENTS. RESIDENT #3 WAS NOT PROVIDED PHYSICIAN ORDERED TREATMENTS FOR A LEG ULCER AND RESIDENTS #5 WAS NOT PROVIDED ANTIPSYCHOTIC MEDICATION FOR A DIAGNOSIS OF SCHIZOPHRENIA. THIS WAS PREVIOUSLY CITED ON JULY 3, 2007. 11 STATE TAG A700-RESIDENT CARE STANDARDS Section 429.19(2)(b), Fla. Stat. (2007) VIOLATIONS; IMPOSITION OF ADMINISTRATIVE FINES; GROUNDS Rule 58A-5.0182, Fla. Admin. Code (2007) RESIDENT CARE STANDARDS 22. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 23. On or about September 26, 2007, AHCA conducted a follow-up monitoring visit at the Respondent’s facility. AHCA cited the Respondent based on the findings below, to wit: a) On or about July 3, 2007, Paradise Manor II failed to provide urinary catheters services for Resident #5. Obtain and follow physician orders for Coumadin for Resident #4. Deliver medications in a correct and timely fashion for Residents #1, #3, #4, and #5. Failure to provide these services can lead to urinary complications, bleeding, and medication errors which could be detrimental to residents’ health conditions. This was previously cited on May 2, 2007. b,) During a follow-up survey on or about September 26, 2007, Paradise Manor Il failed to provide physician medications and treatments orders to care for 2 of 5 sampled residents. Resident #3 was not provided physician ordered treatments for a leg ulcer and Resident #5 was not provided antipsychotic medication for a diagnosis of schizophrenia. This was previously cited on July 3, 2007. The Findings include: 1. While touring the facility on 9-26-2007 at 9:30 a.m, Resident #3 was observed walking through the kitchen with a dressing to his/her right lower leg with netting over it. The Administrator who is a licensed practical nurse stated at this time that the Resident goes to Cora Rehab every 2 weeks for treating the wound. The 12 resident soaks his/her leg daily and she re~wraps the wound.-The Administrator was asked to produce the physician order for treatment of this wound. A letter from Cora was produced signed by the clinic manager giving directions for care of the wound. The clinic manager is not authorized to write medications or treatment orders. The directions listed: Change wounds daily Continue to cleanse with Dakin's solution Dress with Triple Antibiotic Ointment inside of wound Apply 3-4 folds of Unna Boot ona sterile gauze pad. Wrap with kling wrap and apply elastic netting. The Administrator did not have any documentation that this was being done. The facility did not have Dakin's solution or Triple Antibiotic Ointment for the resident. The resident was not receiving Limited Nursing Services (LNS) services for which the facility is licensed to provide. The Administrator stated that she was told (from Cora) to use a mixture of bleach and water to substitute for Dakin's Solution. 2, Resident #5 was admitted to the facility on 7-12-07 with a diagnosis of schizophrenia and bilateral subdural hematoma who needed help with medication assistance. The Administrator on 9-26-07 at 11 a.m. stated that the resident went to ACT Corporation (Community Mental Health Center) in August 2007 and teturned with prescriptions. One of the prescriptions was Geodon 80 mg (antipsychotic), 2 capsules at bedtime. This medication was not on the the resident's August or September 2007 Medication Observation Record. On 9-26-07 at 12 p.m., the Administrator confirmed that this medication was not being given to the resident. Class I] Correction Date: 9/29/07 (Immediate) 24. The regulatory provisions of the Fla. Stat. (2007), that are pertinent to this alleged violation read as follows: 429.19 Violations; imposition of administrative fines; grounds. ~ (2\b) Class "II" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than class I violations. The agency shall impose an administrative fine for a cited class II violation in an amount not less 13 than $1,000 and not exceeding $5,000 for each violation. A fine shall be levied notwithstanding the correction of the violation. ~*~ e * 58A-5.0182 Resident Care Standards. An assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. 25. The violation alleged herein constitutes an uncorrected class II deficiency, and warrants a fine of $5,000.00. WHEREFORE, AHCA demands the following relief: 1. Enter factual and findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $5,000.00. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: 1. . Make factual and legal findings in favor of the Agency on. Count’s I, I, HI, IV and V. 2. Assess against Paradise Manor II an administrative fine in the amount of $7,500.00 for the violation cited above. 3. Grant such other relief as the court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2007). Specific options for administrative action are set out in the atfached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael O. Mathis, Senior Attorney. 14 RESPONDENT IS FURTHER NOTIFED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL REASULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Florida. Fla. Bar. No. 0325570 Counsel of Petitioner, Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 922-5873 (office) (850) 921-0158 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served va by certified mail on ‘7 day of Ten bor. 2007 to Christal L. Caso, Administrator, Michael ©: Mathis, Esq. 435 Greenleaf Square, Port Orange, Florida 32127 15 ipfeted on the reverse side? 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Docket for Case No: 08-000170