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AGENCY FOR HEALTH CARE ADMINISTRATION vs TBJ BEHAVIORAL CENTER, LLC, D/B/A RIVER POINT BEHAVIORAL HEALTH, 10-000265 (2010)

Court: Division of Administrative Hearings, Florida Number: 10-000265 Visitors: 7
Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: TBJ BEHAVIORAL CENTER, LLC, D/B/A RIVER POINT BEHAVIORAL HEALTH
Judges: LAWRENCE P. STEVENSON
Agency: Agency for Health Care Administration
Locations: Jacksonville, Florida
Filed: Jan. 19, 2010
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Monday, July 12, 2010.

Latest Update: Dec. 22, 2024
10{@% STATE OF FLORIDA. AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE _ ADMINISTRATION, Petitioner, . AHCA No. 2009004636 Vs. TBJ BEHAVIORAL HEALTH CENTER, LLC d/b/a RIVER POINT BEHAVIORAL HEALTH, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through undersigned counsel, and files this administrative complaint against TBI BEHAVIORAL CENTER, LLC d/b/a RIVER POINT BEHAVIORAL HEALTH, (hereinafter “Facility” or “Respondent’), pursuant to 120.569 and 120.57, Fla. Stat, (2008). NATURE OF THE ACTION 1, This is an action to impose an administrative fine against a. hospital in the amount of two thousand dollars ($2,000.00), JURISDICTION AND VENUE 2. The Agency has jurisdiction pursuant to § 20.42, 120.60, and 395 Part I, Florida Statutes (2008): 3. . Venue lies pursuant to Fla. Admin. Code R. 28-106,207. PARTIES 4, The Agency is the regulatory body responsible for the licensure of hospitals and the enforcement of all applicable federal and state regulations, statutes and rules, governing Filed January 19, 2010 10:51 AM Division of Administrative Hearings. hospitals pursuant to 5 395, Part I, Florida Statutes (2008), and Fla. Admin. Code R. 59A-3. 5. Respondent operates a hospital located at 6300 Beach Boulevard Jacksonville, Florida 32216, having been issued license number 4011. Respondent was at all times material hereto a hospital under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes, COUNT Respondent’s facility failed to ensure equipment in the dietary department was safe and 6. sanitary. The Agency re-alleges and. incorporates paragraphs one (1) through five (5) as if fully set forth herein. 7. The regulatory provisions of Florida Law that are pertinent to this alleged violation read as follows: 59A-3,2085(1)(j)-(p) Department and Services. (1) Nutritional Care. All licensed hospitals shall have a dietetic department, service or other similarly titled unit which shall be organized, directed and staffed, and integrated with other units and departments of the hospitals in a manner designed to assure the provision of appropriate nutritional care and quality food service, (j) The dietetic department shall be designed and equipped to facilitate the safe, sanitary, and timely provision of food service to meet the nutritional needs of patients. (k) The dietetic department shall have adequate equipment and. facilities to prepare and distribute food, protect food from contamination and spoilage, to store foods under sanitary and secure conditions, and to provide adequate lighting, ventilation and humidity control. (1) The dietetic department shall thoroughly cleanse and sanitize food contact surfaces, utensils; dishes and equipment between periods of use, shall ensure that - adequate toilet, hand-washing and hand-drying facilities are conveniently available, and provide for adequate dishwashing and utensil washing equipment that prevent recontamination and are apart from food preparation areas. (m) The dietetic department shall ensure that all walk-in refrigerators and freezers can be opened from inside and that all food and nonfood supplies are clearly labeled. Where stored in the same refrigerator, all nonfood supplies and specimens shall be stored on separate shelves from food supplies. (n) The dietetic department shall implement methods to prevent contamination in the making, storage, and dispensing of ice. (0) The dietetic department shall ensure that disposable containers and utensils are discarded after one use, and that worn or damaged dishes and glassware are discarded, (p) The dietetic department shall hold, transfer, and dispose of garbage ina manner which does not create a nuisance or breeding place for pests or otherwise pennit the transmission of disease, 8. That on February 16-17, 2009 the Agency conducted a complaint investigation of the Respondent facility, | 9, Based on observation and interview, the facility failed to ensure equipment in the dietary department was safe and sanitary as evidenced by large accumulation of ice on the outside of the freezer door; evidence of a black furry substance on the fan, ceiling and above the slats in the walk in cooler; accumulation of dried liquid on the bottom of the walk in cooler and black furry substance on the fan above the ice machine. Malfunctioning and unsanitary equipment in the kitchen can impact the quality of the food and increases the potential of patients developing a food borne illness. The findings include: a. Observation of the facility's kitchen on 2/16/09 at 10:27 AM, in the presence of the assistant kitchen manager, revealed:a large accumulation of thick ice adhered to the outside of the walk in freezer door, A smaller amount of ice was adhered to opposite outside portion of the door. b. Observation on 2/16/09 at 10:30 AM revealed a large accumulation of a - black furry residue adhered to the fan blades and ceiling of the walk in cooler. The plastic slats near the front door were coated with a slimy ‘residue and the black gray substance could be observed above the slats. A large accumulation of a dried reddish brown residue was observed on the bottom right hand side of the cooler floor. Observation on 2/16/09 at 10:31 AM revealed the fan above the ice machine was filled with dust, dirt, and lint. The fan was observed blowing ‘the residue-over-the ice machine and close to the tray line: : Interview with the Food Service Manager on 2/17/09 at 9:06 AM confirmed the accumulation of ice on the outside of the freezer door as well as the accumulation of a black furry substance on the fans, ceiling: and above the slats in the walk in cooler. He also confirmed the dried liquid spillage on the bottom half of the walk in cooler. He stated the ice buildup was probably from the warped door to the freezer and the door not closing properly. He stated that the ice buildup and spillages were nothing new and had been there awhile. 10. That the Agency provided the Respondent’s facility with a mandatory correction date of March 17, 2009. , 11. That the failure to ensure equipment in the dietary department was safe and sanitary is in violation of law. 42. That the above cited deficiency subjects the Respondent to the imposition of an administrative penalty in a sum not to exceed one thousand dollars per violation, per day, — , pursuant to Section 395.1065(2)(a), F.S. (2008) WHEREFORE, the Agency intends to impose an administrative fine in the amount of one thousand dollars ($1,000.00) against the Respondent, pursuant to 395.1605(2)(a) Florida Statutes (2008): ) COUNT I Respondent’s facility failed to ensure that medications were prepared, stored, and administered according to accepted standards of practice as evidenced by nurses pulling and preparing medications to be administered to patients 3-4 hours before they were due to be administered. 13, The Agency re-alleges and incorporates paragraphs one (1) through five (5) as if fully set forth herein. 14, The regulatory provisions of Florida Law that are pertinent to this alleged violation read. as follows: 59A-3.2085(5)(d) Department and Services, *(5y Nursing” Serview: Each’ hospital’ shall be organized” arid’ staffed “to “provide - quality nursing care to each patient. Where a hospital’s organizational structure does not have a nursing department or service, it shall document the organizational steps it has taken to assure that oversight of the quality of nursing care provided to each patient is accomplished. (d) Each hospital shall develop written standards of nursing practice and related policies and procedures to define and describe the scope and conduct of patient care provided by the nursing staff. These policies and procedures shall be reviewed at least annually, revised as necessary, dated to indicate the time of the last review, signed by the responsible reviewing authority, and enforced. 15. That on February 17, 2009 the Agency conducted a complaint investigation of the Respondent facility. 16. Based on observations, interviews and review of hospital policies and procedures for Medication Administration, the facility failed to assure that medications were prepared, stored, and administered according to accepted standards of practice as evidenced by nurses pulling and preparing medications to be administered to patients 3-4 hours before they were duc © to be administered. Failing to safely store, prepare and administer medications may lead to cross-mixing of medications and patients receiving the wrong drug or dose of the medication which can increase the risk of a serious drug reaction, The findings include: a. Observation of the medication room in the presence of a staff nurse and the Director of Nursing (DON) on the ESU (Emergency Stabilization Unit) on 2/16/09 at 9:50 AM revealed 6 medication cups filled with medications for patients, The names and times of 1:00 were labeled on the cups. The staff nurse was asked if medications could be pulled ahead of time and she confirmed they could as long as they were in their original packets. One of the 6 cups contained an unidentified medication out of its original package. The nurse was asked when she pre-poured the medications and she stated she got them ready at 9:00 AM for the 1:00 PM medication pass. b. Observation. of the medication room in the presence of a second staff nurse and the DON on the CD (Chemical Dependence) unit on 2/16/09 at ; 9:57AM revealed a tray holding pre-poured medications in pill cups. The - medications were labeled 1:00. According to the nurse, she pulled the medications at 9:00 AM for the 1:00 PM medication pass and stated the medications can be pulled early and left out as long as they are not out of their (individual) packages. . c. Observation of the medication toom on the Adolescent unit in the “presence of a’ third staff nurse ‘and “the ‘DON on 2/16/09 at-10:15 AM ~ revealed 4 medication cups filled with medications and for the times of 12:00, 1:00 and 2:00. The medications were out of their original packages. Interview with this nurse during the observation revealed medications can be-pulled ahead of time as long as they are labeled with names and times, The nurse stated she pulled these medications at 9:00 AM and the medications were for the afternoon medication pass. She stated she is the only nurse giving medications today and knows the patients. Because she knew the patients, she stated she could remove them from their original package and put the medications in the cups. She stated some nurses don't pull them out because they are new and not familiar with the patients. : d, Interview with the consultant Pharmacist on 2/16/09 at 12:41 PM revealed nurses are not to pre-pull or pre-pour their medications, He stated it is against facility policy to store medications other than in the original packets and in the appropriate container in the medication carts. He stated the nurses should not be preparing medications in advance of the ordered time of administration and letting them sit out until they are administered, e, Interview with the DON on 2/16/09 at 1:30 PM confirmed the nurses should not be preparing medications in advance of administration time. f. Review of the Department of Pharmacy's policy and procedures for medication storage, page 1 of 4, #1, revealed oral medications not requiring refrigeration will be stored in the patients' assigned medication. cassettes, Bach cassette will be labeled with the patient's name. When not in use, the medication nurse will lock the medication cassettes in a medication room, which can be secured at all times. g. Review of the Nursing policy and procedure for Medication Administration, page 1, #8, revealed nurses will remove unit doses of drugs and remove the seal of the drug and hand it to the client/patient with sufficient, suitable liquid to swallow the drug. The nurse may alternatively place the oral drug into a medication cup and present that to the client/patient with suitable liquid. (There is no evidence in the policy which indicates nursing can pre-pull medications and administer the medications at a later time other than during the medication pass when the patient is present.) 17. That the Agency provided the Respondent’s facility with a mandatory correction _ date of March 17, 2009. 18. That the failure to ensure that medications were prepared, stored, and administered according to accepted standards of practice as evidenced by nurses pulling and preparing medications to be administered to patients 3-4 hours before they were due to be administered i isin 1 violation of law. 19. That the above cited deficiency subjects the e Respondent to the imposition of an administrative penalty in a sum not to exceed one thousand dollars per violation per day, pursuant to Section 395.1065(2)(a), F.S. (2008) WHEREFORE, the Agency intends to impose an administrative fine in the amount of one thousand dollars ($1,000.00) against the Respondent, a hospital, pursuant to 395.1605(2)(a) Florida Statutes (2008). CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court: (A) Make factual and legal findings in favor of the Agency on Counts Land I; (B) Recommend administrative fines against Respondent in the amount of $2,000.00 for Counts I and Il; | (C) Assess attorney’s fees and costs; and (D) Grant all other general and equitable relief allowed by law, Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights form. All requests for hearing shall be made to the attention of Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308, (850) 922-5873. If you want to hire an attorney, you have the right to be represented by an attorney in this matter. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST 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 A FINAL ORDER BY THE AGENCY. na Te eee mo mmnn Resnectfully submitted this 4 lo day of ‘October; 2009.-0 _ Kes l- Senior Attorney Florida Bar No. 49402 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 850.922.4347 (office) 850.921.0158 (fax) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7004 2890 0000 5526 3539 to: Facility, River Pointe Behavioral Health, 6300 Beach Boulevard, Jacksonville, Florida 32216, and by U.S. Certified Mail, Return Receipt No. 7004 2890 0000 5526 3546 to; Registered Agent, C T Corporation Systems, 1200 South Pine Island Road, Plantation, Florida 33324, and by U.S. Certified Mail, Retum Receipt No. 7004 2890 0000 5526 3553 to: Owner, yun Behavioral Center, LLC, 6640 ’ Carothers Parkway, Suite 500, Franklin, TN 37067 on ovtoreyt, 2009, joee bb Vikram Mohan, Esquire Copy furnished to: Rob Dickson, FOM USPS - Track & Confirm. Page 1 of 1 RPA, og, Track & Confirm Track & Confirm Search Results Label/Receipt Number: 7004 2890 0000 5526 3539 Service(s): Certified Mail” Track & Confirm Status: Delivered Enter Labe!/Receipt Number. Your item was delivered at 12:29 PM on October 13, 2009 in JACKSONVILLE, FL 32216. (tox) Y Site Map Customer Service Forms Gov't Services Careers Privacy Policy Terms of Use Business Customer Gateway Perks Wop horton, Copyright® 2009 USPS. All Rights Reserved. No FEAR Act EEO Data FOIA Sa ones: Vnicratiip detoegg ty http://trkenfrm1.smi.usps.com/PTS Internet Web/InterLabelInquiry.do 1/15/2010 USPS - Track & Confirm Page 1 of 1 EARLE, et Track & Confirm Track & Confirm Search Results Label/Receipt Number: 7004 2890 0000 5526 3553 nerrenergeeucrne in Service(s): Certified Mail™ Track & Confimi Status: Delivered Enter Label/Receipt Number. Your item was delivered at 1:49 PM on October 13, 2009 in FRANKLIN, . TN 3706700 res do» Le Site Map Customer Service Forms Gov't Services Careers Privacy Policy Terms of Use Business Customer Gateway . SOI Pete lapkas book Prati. Copyright© 2009 USPS. All Rights Reserved. No FEAR Act FEO Data FOIA Cinrord gg Bee Howl Pesta iy Bitty ty http://trkcnfrm1.smi.usps.com/PTSInternetWeb/InterLabelInquiry.do 1/15/2010

Docket for Case No: 10-000265
Issue Date Proceedings
Jul. 12, 2010 Order Closing Files. CASE CLOSED.
Jul. 06, 2010 Joint Motion to Relinquish Jurisdiction filed.
May 18, 2010 Order Granting Continuance.
May 13, 2010 Joint Status Report and Motion for Further Continuance Pending Settlement Talks filed.
Apr. 07, 2010 Order Granting Continuance (parties to advise status by May 14, 2010).
Apr. 06, 2010 Joint Motion for Continuance filed.
Mar. 03, 2010 Respondent's First Request for Admissions to AHCA filed.
Mar. 03, 2010 Respondent's First Request for Production of Documents to AHCA filed.
Mar. 03, 2010 Respondent's Notice of Service of First Interrogatories to AHCA filed.
Feb. 26, 2010 Petitioner's Notice of Service of Discovery on Respondent filed.
Jan. 28, 2010 Order of Pre-hearing Instructions.
Jan. 28, 2010 Notice of Hearing (hearing set for April 28 through 30, 2010; 9:00 a.m.; Jacksonville, FL).
Jan. 28, 2010 Order of Consolidation (DOAH Case Nos. 10-0265).
Jan. 19, 2010 Initial Order.
Jan. 19, 2010 Notice (of Agency referral) filed.
Jan. 19, 2010 Request for Formal Administrative Hearing filed.
Jan. 19, 2010 Administrative Complaint filed.
Source:  Florida - Division of Administrative Hearings

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