OPI a ‘a "Rey & STATE OF FLORIDA 18 { AGENCY FOR HEALTH CARE ADMINIS TRB IOW hy Me ye, 9, AGENCY FOR HEALTH CARE Oe ADMINISTRATION, ipa Petitioner, AHCA No.: 2007010233. v. : Return Receipt Requested: 7002 2410 0001 4235 9602 BAYVIEW HOLDINGS, INC., d/b/a BAYVIEW RETIREMENT HOME, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Bayview Holdings, Inc. d/b/a Bayview Retirement Home (hereinafter ‘Bayview Retirement Home”), pursuant to Chapter 429, Part I, and Section 120.60, Florida Statutes, (2007), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $10,750.00 pursuant. to Section 429.19, Florida Statutes (2007), for the protection of the public health, safety and welfare pursuant to Section 429.28(3)(c), Florida Statutes (2007). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, and 28-106, Florida Administrative Code. 3. Venue lies in Broward County, pursuant to Section 120.57, Florida Statutes and Rule 28-106.207, Florida Administrative Code. 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, Florida Statutes (2007), and Chapter 58A-5, Florida Administrative Code. 5. Bayview Retirement Home operates a 12-bed assisted living facility located at 2625 N.E. 137 court, Fort Lauderdale, Florida 33304. Bayview Retirement Home is licensed as an assisted living facility license number AL10479, with an expiration date of July 12, 2008. Bayview Retirement Home was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I BAYVIEW RETIREMENT HOME FAILED TO MAINTAIN AN UP-TO-DATE AND ACCURATE MEDICATION OBSERVATION RECORD (MOR) Rule 58A-5.0185(5) (b), Florida Administrative Code (MEDICATION STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the second revisit conducted on 7/31/07 and based on record review and interview with the Administrator at approximately 11:00 AM, on the day of the survey, the facility failed to maintain an accurate Medication “Observation Record (MOR) for one of six current resident records reviewed. The assisting of residents with medications and not maintaining an accurate record directly threatens the physical health of these residents. 8. A review of the July 2007 MOR and medications for Resident #1 revealed the resident was prescribed Depakote 250 mg, 1 tab BID and Lasix 40 mg, 2 tabs BID. The Medication Observation Record (MOR) for this resident stated Depakote 1 tab BID and Lasix 40 mg, 2 tabs BID. The Administrator/facility staff signed the MOR when these medications were assisted in the AM and not in the PM for the entire month of July 2007.. The Administrator when interviewed stated she did not know that she had to sign the MOR each time she provided the resident with medication assistance per the physician's order. 9. The absence of accurate documentation of medication assistance as prescribed by the residents' physicians directly threatens the physical health of these residents. 10. This was confirmed by the Administrator on 7/31/07 at approximately 12:00 PM. This deficiency was previously cited during the 4/30/07 complaint investigation and the 6/20/07 follow-up visit. 11. Based on the foregoing, Bayview Retirement Home violated Rule 58A-5.0185(5) (b), Florida Administrative Code, a Class II deficiency, which carries, in this case, an assessed fine of $10,000.00. ($1,000.00 per day commencing on July 22, 2007) . COUNT ITI BAYVIEW RETIREMENT HOME FAILED TO EMPLOY THE SERVICES OF A PHARMACIST AS WAS DIRECTED . Section 429.42(1), Florida Statutes, and/or Rule 58A-5.033(4) (a)1., Florida Administrative Code (MEDICATION STANDARDS) UNCORRECTED CLASS III VIOLATION 12. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 13. During the follow-up visit conducted on 6/20/07 and based on record review and interview with the Administrator, at approximately 12:00 PM on the day of the survey, the facility failed to employ the services of a pharmacist as was directed in the survey report of 4/30/07 pursuant to the provisions of Chapter 429.42 Florida Statutes, and 58A-5.033(4) Florida Administrative Code. 14. The facility at this survey did not maintain an accurate Medication Observation Record (MOR) for three of six current resident records reviewed. The assisting of residents with medications and not maintaining an accurate record directly threatens the physical health of these residents. 15. The facility was again found to be centrally storing an unlabeled bottles of Over The Counter medications. 16. The above medication problems were found to be uncorrected at this survey on 6/20/07. The facility failed to employ or obtain the services of a pharmacist, as was directed in the survey report of 4/30/07, pursuant to the provisions of Chapter 429.42 Florida Statutes, and Rule 58A- 5.033(4) Florida Administrative Code, to correct and review the facility's medication practices. This was confirmed by the Administrator on 6/20/07 at approximately 12:00 PM. Mandated Correction Date: 7/21/07 17. During the second revisit conducted on 7/31/07 and based on record review and interview with the Administrator at approximately 11:30 AM, on the day of the survey, the facility failed to employ the services of a pharmacist as was directed in the survey report of 4/30/07 and 6/20/07 pursuant to the provisions of Chapter 429.42 Florida Statutes, and Rule 58A-5.033(4) Florida Administrative Code. 18. The facility at this survey did not maintain an accurate Medication Observation Record (MOR) for one of six current resident records reviewed. The facility’s failure to provide appropriate assistance with medications to the residents and its failure to maintain an accurate medication observation record (MOR) directly threatens the physical health of these residents. 19. The above medication problem was found to be uncorrected at this survey on 7/31/07. The facility failed to employ or obtain the services of a pharmacist, as was directed in the survey report of 4/30/07, pursuant to the provisions of Chapter 429.42 Florida Statutes, and Rule 58A- 5.033(4) Florida Administrative Code, to correct and review the facility's medication practices. 20. This was confirmed by the Administrator on 7/31/07 at approximately 12:00 PM. This is an uncorrected deficiency from the 6/20/07 survey report. 21. Based on the foregoing, Bayview Retirement Home violated Section 429.42(1), Florida Statutes, and/or Rule 58A-5.033(4) (1), Florida Administrative Code, an uncorrected Class III deficiency, which carries, in this case, an assessed fine of $750.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Counts I and II. B. Assess an administrative fine of $10,750.00 against Bayview Retirement Home on Counts I and II pursuant to Sections 429.19, and 429.28(3)(c), Florida Statutes. Cc. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2007). Specific options for administrative action are set out in the attached Election of Rights Form. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, attention Agency Clerk, telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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 FIN, ORDER BY, THE AGENCY. ria Lawton-Russell Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52"? Terrace Suite 103 Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (U.S. Mail) Finance and Accounting Revenue and Management Unit Agency for Health Care Administration 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 (Inter-office Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Alice Rothman, Administrator and Registered Agent, Bayview Retirement Home, /2625 pe Court, Fort Lauderdale, Florid 200€. ria Lawton-Russell

Docket for Case No: 08-000816

Orders for Case No: 08-000816