STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ~ ADMINISTRATION, Petitioner, vs. Case No. 2009011059 BROOKDALE SENIOR LIVING COMMUNITIES, INC. d/b/a CLARE BRIDGE OF VENICE, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, BROOKDALE SENIOR LIVING COMMUNITIES, INC. d/b/a CLARE BRIDGE OF VENICE (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2009), and states: NATURE OF THE ACTION This is an action to impose ari administrative fine against an assisted living facility in the sum of ONE THOUSAND SEVEN HUNDRED FIFTY DOLLARS ($1,750.00) based upon “three (3) uncorrected Class IIf deficiencies pursuant to Section 429.19(2)(c), Florida Statutes (2009). . . JURISDICTION AND VENUE 1. The Court has jurisdiction over the matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2009). 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 (2009). Filed May 25, 2010 2:12 PM Division of Administrative Hearings. 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. 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 such facilities. Chapters 408, Part II, and 429, Part I, Florida Statutes (2009); 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 (2009). Sections 408.813, 408.815 and 429.14, Florida Statutes (2009). 5. The Respondent was issued a license by the Agency (License Number 9071) to operate a 60-bed assisted living facility located at 1200 Avenida Del Circo, Venice, Florida 34285, and was at all times material required to comply with the applicable federal and state regulations, statutes and rules governing assisted living facilities. COUNT I The Respondent Failed To Maintain A Daily Medication Observation Record For Each Resident Who Receives Assistance With Self-Administration Of Medications Or Medication Administration In Violation Of Rule 58A-5.0185(5)(b), Florida Administrative Code 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, Sections 429.255 and 429.256, Florida Statutes (2009), and Rule 58A-5.0185, Florida Administrative Code, facilities holding a standard, limited mental health, extended congregate care, or limited nursing services license may assist with the self- administration or administration of medications to residents in a facility. A resident may not be compelled to take medications but may be counseled in accordance with Rule 58A-5.0185, Florida Administrative Code. The facility shall maintain a daily medication observation record for each resident who receives assistance with self-administration of medications or medication 2 administration. A medication observation record 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 medication observation record must be immediately updated each time the medication is offered or administered. Rule S8A- 5.0185(5)(b), Florida Administrative Code. . 8. On or about July 8, 2009 through July 9, 2009 the Agency conducted a Biennial Survey of the Respondent’s facility. 9. Based on observation, interview with staff and record review, the facility failed to ensure it maintained an accurate daily Medication Observation Record for each resident who received assistance with self-administration of medications or medication administration. This was evidenced by one (1) of three (3) random sampled residents spitting out a pill, Resident number seven (7), and the nurse documenting the pill was administered. 10. An observation on July 9, 2009 at 8:00 a.m. revealed a cup of juice on the medication cart, The medication nurse was asked what was floating in the juice; she stated "Resident number seven (7) spit a pill back into the juice." She proceeded to throw the cup away in the nurses’ office. 11. Areview of the Medication Observation Record at 11:00 a.m. in the presence of the Health Wellness Director revealed the nurse had documented the resident received all a.m. medications. There was no documentation on the Medication Observation Record that showed the resident had spit out a pill. After reviewing the medications given, the Health Wellness Director determined the medication which was refused was Haldol. 12. =‘ The medication nurse stated she should have written it on the Medication Observation Record. 13. The Respondent’s deficient practice was related to the operation and maintenance of a provider or to the care of clients which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of clients, other than Class I or Class II violations, and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2009). 14. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2009). 15. = The Respondent was given a mandatory correction date of August 9, 2009. 16. On or about August 27, 2009, the Agency conducted a Follow-Up Survey to the Biennial Survey of July 8, 2009 through July 9, 2009 of the Respondent’s facility. 17. Based on observation, interview, and clinical record review, the facility failed to maintain accurate up-to-date Medication Observation Records for two (2) of four (4) sampled residents, Resident number one (1) and Resident number two (2). 18. | A review of the clinical record for Resident number one (1) on August 27, 2009 noted an order dated August 11, 2009 for Ativan 0.5 milligrams every four (4) hours as needed by mouth or intramuscular injection. A review of the Medication Observation Record for Resident number one (1) revealed an entry for Ativan by mouth, but not an entry for it to be administered intramuscularly. 19. At an interview with the facility nurse on August 27, 2009 at 11:19 a.m., the nurse stated it was not placed on the Medication Observation Record because the nurses in the facility are not allowed to administer intramuscular injections. 20. Atan interview with the facility Executive Director on August 27, 2009 at 11:50 a.m., the Executive Director stated that the nurses can administer medications by the intramuscular route, it was just not a preferred route to utilize. The Executive Director confirmed the medication order was not transcribed properly to the Medication Observation Record. 4 21. Arreview of the orders in the clinical record for Resident number two (2) revealed an order dated July 23, 2009 to restart Januvia 100 milligrams one (1) tablet by mouth daily. A review of the Medication Observation Record for Resident number two (2) noted no transcription for the medication Januvia. . 22. At an interview with the facility nurse on August 27, 2009, the nurse stated Resident number two (2) had not been receiving Januvia. The nurse reviewed the July Medication Observation Record, which indicated Resident number two (2) had received the medication after being ordered on July 23, 2009. The nurse confirmed the order had been missed being transcribed to the August Medication Observation Record at the end of the month changeover. An observation of the medications in the medication cart for Resident number two (2) revealed a container labeled Januvia 100 mg. 23. This remains an uncorrected deficiency. 24. The Respondent’s deficient practice was ‘related to the operation and maintenance of a provider or to the care of clients which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of clients, other than Class I or Class II violations, and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2009). 25. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19 (2)(c), Florida Statutes (2009). . 26. The Respondent’s deficient practice constituted an uncorrected Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2009). 27. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. Section 429.19(2)(c), Florida Statutes (2009). 28. The Respondent was given a mandatory correction date of September 27, 2009. 5 WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of SEVEN HUNDRED FIFTY DOLLARS ($750.00) pursuant to Section 429.19(2)(c), Florida Statutes (2009). COUNT II The Respondent Failed To Ensure That Medications Were Properly Labeled In Violation Of Rule 58A-5.0185(7)(a), Florida Administrative Code ‘29. The Agency ré-alleges and incorporates by reference paragraphs one (1) through five (5). 30. Pursuant to Florida law, Sections 429.255 and 429.256, Florida Statutes (2009), and Rule 58A-5.0185, Florida Administrative Code, facilities holding a standard, limited mental health, extended congregate care, or limited nursing services license may assist with the self- administration or administration of medications to residents in a facility. A resident may not be compelled to take medications but may be counseled in accordance with Rule 58A-5.0185, Florida Administrative Code. No prescription drug shall be kept or administered by the facility, including assistance with self-administration of medication, unless it is properly labeled and dispensed in accordance with Chapters 465 and 499, Florida Statutes (2009), and Rule 64B16- 28.108, Florida Administrative Code. If a customized patient medication package is prepared for a resident, and separated into individual medicinal drug containers, then the following information must be recorded on each individual container: The -resident’s name and identification of each medicinal drug product in the container. Rule 58A-5.0185(7)(a), Florida Administrative Code. 31. On or about July 8, 2009 through July 9, 2009 the Agency conducted a Biennial Survey of the Respondent’s facility. 32. Based on observation, interview with staff and record review, the facility failed to ensure a prescription drug kept or administered by the facility, including assistance with self- 6 administration of medication, was properly labeled. This is evidenced by one (1) of four (4) sampled residents not having the correct label inserted in the package containing Imodium AD, Resident number four (4). 33. Areview of the physician's orders for Resident number four (4) revealed the following order dated December 31, 2008: Acute-Imodium AD caps two (2) mg- take two (2) by mouth then one (1) after each loose stool up to 16 mg/ twenty-four (24) hour PRN (when needed). If chronic- two (2) tabs initially then one (1) by mouth after each loose stool- max four (4) tabs/day as needed. 34. Anobservation on July 8, 2009 at 2:30 p.m. of the medications in the medication cart for Resident number four (4) revealed a plastic bag with Imodium AD 2 mg. The directions read: Imodium as needed (Over the Counter) two (2) mg two (2) caps onset then one (1) after for loose stools. It did not have the limitations listed. 35, Aninterview with the Health Wellness Director on July 9, 2009 at 10:00 a.m. confirmed the label was not correct. 36. The Respondent’s deficient practice was related to the operation and maintenance of a provider or to the care of clients which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of clients, other than Class I or Class II violations, and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2009). 37. | The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2009). 38. The Respondent was given a mandatory correction date of August 9, 2009. 39. On or about August 27, 2009, the Agency conducted a Follow-Up Survey to the Biennial Survey of July 8, 2009 through July 9, 2009 of the Respondent’s facility. 40. Based on observation, interview and clinical record review, the facility failed to ensure prescribed medications are properly labeled by a licensed pharmacist, prescribing physician, or an Advanced Registered Nurse Practitioner for one (1) of four (4) sampled residents, Resident number one (1). 41. While reconciling the medications for Resident number one (1) on August 27, 2009 at 11:52 p.m. with the Executive Director and facility nurse, noted were four (4) prescribed over the counter medication: aspirin, multivitamins, Omega-3 vitamins and Homocystine with photo copies of the original physicians order attached to the bottles by a rubber band. Resident number one (1), documented in the health assessment, requires assistance with medication administration. 42. Ariinterview with the Executive Director and facility nurse revealed the bottles were obtained over-the-counter by Resident number one’s (1) family and confirmed they were not labeled by a licensed pharmacist, physician, or an Advanced Registered Nurse Practitioner. 43, This remains an uncorrected deficiency. 44. The Respondent’s deficient practice was related to the operation and maintenance of a provider or to the care of clients which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of clients, other than Class I or Class I violations, and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2009). 45. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19 (2)(c), Florida Statutes (2009). 46. The Respondent’s deficient practice constituted an uncorrected Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2009). 47. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. Section 429.19(2)(c), Florida Statutes (2009). 48. The Respondent was given a mandatory correction date of September 27, 2009. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to Section 429.19(2)(c), Florida Statutes (2009). COUNT IT The Respondent Failed To Ensure Documentation Of Complete Instructions For Use Of As Needed Medications For A Resident In Violation Of Rule 58A-5. PBSC), Florida Administrative Code 49. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). . 50, Pursuant to Florida law, Sections 429.255 and 429.256, Florida Statutes (2009), and Rule 58A-5.0185, Florida Administrative Code, facilities holding a standard, limited mental health, extended congregate care, or limited nursing services license may assist with the self- administration or administration of medications to residents in a facility. A resident may not be compelled to take medications but may be counseled in accordance with Rule 58A-5.0185, Florida Administrative Code. If the directions for use are “as needed” or “as directed,” the health care provider shall be contacted and requested to provide revised instructions, For an “as needed” prescription, the circumstances under which it would be appropriate for the resident to request the medication and any limitations shall be specified; for example, “as needed for pain, not to exceed 4 tablets per day.” The revised instructions, including the date they were obtained from the health care provider and the signature of the staff who obtained them, shall be noted in the medication record, or a revised label shall be obtained from the pharmacist. Rule 58A- 5.0185(7)(c), Florida Administrative Code. $1. On or about July 8, 2009 through July 9, 2009 the Agency conducted a Biennial Survey of the Respondent’s facility. 52. Based on interviews with staff and record review, the facility failed to ensure the health care provider was contacted and requested to provide revised instructions for medication directions that were "as needed.” This is evidenced by two (2) of four (4) sampled residents having an order for Tylenol for elevated temperature, with no parameter as to what temperature is considered to be elevated, Resident number two (2) and Resident number three (3). 53. A review of the physicians orders for Resident number two (2) revealed an order for Tylenol 325 mg., 2 tablets (650 mg) PRN (when needed) pain/ elevated temperature. There was no parameter for what would be considered an elevated temperature. 54. During an interview with the Health Wellness Director on July 9, 2009 at 10:00 a.m., she confirmed the orders did not state what was considered an elevated temperature. She stated she would contact the physicians to clarify the orders. 55. On July 8, 2009, a review of records for Resident number three (3) revealed a physician's order for Acetaminophen 325mg two (2) tablets every six (6) hours as needed for pain or elevated temperature. This order does not indicate the severity of pain required for the Acetaminophen nor does it indicate at what temperature to give the Acetaminophen. 56. An interview with the Health Weliness Director on July 8, 2009 at 9:15 a.m. confirmed the order needed clarification so the Acetaminophen could be given for the appropriate use. She stated the usual temperature Acetaminophen would be given would be 101F but without clarification from the physician she was unable to determine when to give it. 57. The Respondent’s deficient practice was related to the operation and maintenance of a provider or to the care of clients which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of clients, other than Class I or Class II violations, and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2009). 10 58. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19(2)(c), Florida Statutes (2009). 59. The Respondent was given a mandatory correction date of August 9, 2009. 60. On or about August 27, 2009, the Agency conducted a Follow-Up Survey to the Biennial Survey of July 8, 2009 through July 9, 2009 of the Respondent’s facility. 61. Based on interview and clinical record review, the facility failed to ensure documentation of complete directions for use for "as needed" medications for one (1) of four (4) sampled residents, Resident number one (1). 62. Areview of the clinical record for Resident number one (1) documented an order on August 11, 2009 for Ativan 0.5 milligrams by mouth or intramuscularly every four (4) hours as needed. A review of the Medication Observation Record noted a transcription for the Ativan 0.5mg by mouth every four (4) hours as needed. There is no reason documented for why the medication is to be given either on the Medication Observation Record or the written physician order. 63. | Atan interview with the Executive Director on August 27, 2009 at 11:52 a.m., the Executive Director stated the medication is for Resident number one’s (1) anxiety and confirmed the required information was missing. 64. This remains an uncorrected deficiency. 65. The Respondent’s deficient practice was related to the operation and maintenance of a provider or to the care of clients which the Agency determined indirectly or potentially threatened the physical or emotional health, safety, or security of clients, other than Class I or Class II violations, and constituted a Class III deficiency as provided for in Section 429.19(2)(c), Florida Statutes (2009). 66. The Agency cited the Respondent for a Class III violation in accordance with Section 429.19 (2)(c), Florida Statutes (2009). 11 67. . The Respondent’s deficient practice constituted an uncorrected Class IIT violation in accordance with Section 429.19(2)(c), Florida Statutes (2009). 68. The Agency shall impose an administrative fine for a cited Class III violation in an amount not less than five hundred dollars ($500.00) and not exceeding one thousand dollars ($1,000.00) for each violation. Section 429.19(2)(c), Florida Statutes (2009). 69. The Respondent was given a mandatory correction date of September 27, 2009. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of FIVE HUNDRED DOLLARS ($500.00) pursuant to Section 429.19(2)(c), Florida Statutes (2009). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to grant the following relief: 1, Enter findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the amount of ONE THOUSAND SEVEN HUNDRED FIFTY DOLLARS ($1,750.00). 3. Order any other relief that the Court deems just and appropriate. Respectfully submitted on this AVM day of Gnail , 2010. tat nice kyjfas Assistant General Counsel Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 335-1253 12 NOTICE - RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TO RETAIN AND BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS. ALL REQUESTS FOR HEARING SHALL BE MADE AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 922-5873. THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING 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 BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form were served to: CT Corporation System, Registered Agent for Brookdale Senior Living Communities, Inc. d/b/a Clare Bridge of Venice, 1200 South Pine Island Road, Plantation, Florida 33324, by United States Certified Mail, Return Receipt No. 7009 1680 0001 8777 0830 and to Sandra Durden, Administrator, Brookdale Senior Living Communities, Inc. d/b/a Clare Bridge of Venice, 1200 Avenida Del Circo, Venice, Florida 34285, by United States Certified Mail, Return Receipt No. 7009 1680 0001 8777 0823 on this Hh. day of quit. 2010. ar ee J hy a Assistant General Counsel Florida Bar No. 0355712 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (239) 335-1253 13 Copies furnished to: Sandra Durden, Administrator Brookdale Senior Living Communities, Inc. Mary Daley Jacobs, Assistant General Counsel Agency for Health Care Administration d/b/a Clare Bridge of Venice Office of the General Counsel 1200 Avenida Del Circo 2295 Victoria Avenue, Room 346C Venice, Florida 34285 Fort Myers, Florida 33901 (U.S. Certified Mail) (Interoffice Mail) CT Corporation System Harold Williams i Registered Agent for Field Office Manager Brookdale Senior Living Communities, Inc. d/b/a Clare Bridge of Venice 1200 South Pine Island Road Plantation, Florida 33324 (U.S. Certified Mail) Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (interoffice Mail) 14 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY im Complete items 1, 2, and 3. Also’ complete. {| A:Slanayen a a An ne )'Item-4 if Restricted Delivery \s desired..." : Ray “OER i D Agent + Ml Print your name and address On. the reverse . (J) Addressee _- |" 8o:that.we can return the card to your: ©; Daie of Dell: | @ Attach this card to the back of the mailplece;: eae i... .or.on the front If space permits. | 1. Articte Addressed to: | CT Gp: ia Ived by (Printed Name) > OREN. RUDIN i, 2: Arllcle Number ; : ereyes |. (Transfer trom service fabel) |! PS Form 3811, February 2004 Domeste Return Receipt

Docket for Case No: 10-002832

Orders for Case No: 10-002832