STATE OF FLORIDA ARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2010008287 2010008288 ARC VILLAGES IL, LLC d/b/a FREEDOM POINTE AT THE VILLAGES REHABILITATION AND HEALTHCARE, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against ARC Villages IL, LLC d/b/a Freedom Pointe at the Villages Rehabilitation and Healthcare, (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2010), and alleges: NATURE OF THE ACTION This is an action to change Respondent’s licensure status from Standard to Conditional commencing July 8, 2010 and ending August 16, 2009, and impose an administrative fine in the amount of one thousand dollars ($1,000.00), based upon Respondent being cited for one uncorrected isolated State Class HI deficiency. JURISDICTION AND VENUE 1, The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2010). Filed October 22, 2010 3:54 PM Division of Administrative Hearings. oT 2. Venue lies pursuant to Florida Administrative Code R, 28-106,207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of nursing homes and enforcement of applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), Chapters 400, Part I, and 408, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4. Respondent operates a 72-bed nursing home, located at 1460 Ef Camino Real, The Villages, Florida 32159, and is licensed as a skilled nursing facility license number 130471043. 5. Respondent was at all times material hereto, a licensed nursing facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That pursuant to Florida law, all physician orders shall be followed as prescribed, and if not followed, the reason shall be recorded on the resident’s medical record during that shift. Rule 59A-4.107(5), Florida Administrative Code, 8. That pursuant to Florida faw, each facility shall adopt procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident. Rule 59A-4.112(1), Florida Administrative Code. 9. That on or about May 28, 2010, the Agency conducted a compliance complaint investigation of Respondent’s facility. 10. That based on observation, the review of records, and interview, Respondent failed to follow physician's orders for acquiring and administering medications for two (2) of four (4) sampled residents, the same being contrary to the minimum requirements of law. 11. That Petitioner’s representative reviewed Respondent’s records related to resident number one (1) and noted as follows: a, The resident was admitted from the hospital to Respondent facility on May 5, 2010 for rehabilitation and intravenous (IV) therapy; The resident had a history of urinary tract infection, and E Coli Septicemia for which the resident was ordered intravenous (IV) antibiotics; Discharge physician’s orders from the resident's hospitalization dated May 3, 2010 provided; i. "1 gram (GM) of Vancomycin intravenous (IV) every !2 hours for 2 weeks," ii. "2 gram (GM) of Ceftazidime (Fortaz) IV every 12 hours for 2 weeks." The resident's facility physician had ordered and written on May 5, 2010 to start Vancomycin 1 gram in Dextrose 5% 250 milliliter (ml) via IV every 12 hours at 6:00 AM and 6:00 PM and infused over two hours. Also ordered was Ceftazidime (Fortaz) 2 gram in normal saline (ns) 0.9% 100 ml via IV every 12 hours at 9:00 AM and 9:00 PM. These medications were medically necessary for treatment of the resident’s septicemia; The resident’s Medication Administration Record (MAR) reflected as follows: i. The resident arrived at this facility on May 5, 2010 at 2:20 PM ii, Respondent failed to administer the resident’s prescribed IV antibiotic of Vancomycin at 6:00 PM iii. Respondent failed to administer the resident’s prescribed IV antibiotic of Ceftazidime (Fortaz) at 9:00 PM iv. Respondent failed to administer on Masy 6, 2010 the resident’s prescribed TV antibiotic of Vancomycin at 6:00 AM and the resident’s prescribed IV antibiotic of Ceftazidime (Fortaz) at 9:00 AM. Nursing notes did not reflect that the resident’s physician had been notified on May 5 or 6, 2010 of Respondent’s failure to administer the prescribed doses of IV antibiotics as above referenced; The medication administration record for the resident had circles for the dates and times of administration for the missed dosages referenced above which reflected that the antibiotics were not administered; Noted on the back of the medication administration record was that the antibiotics Vancomycin and Ceftazidime (Fortaz) were not given and unavailable from the pharmacy; The resident’s medication administration record (MAR) also reflects that the resident was scheduled to receive additional physician ordered medications starting on May 5, 2010 and the following additional medications were not administered on the following dates: i, Sinemet 25-100 mg ordered one tablet to be administered every 8 hours, not administered on May 5, 2010 at 10:00 PM and noted unavailable from the pharmacy; pan iti. vi. vii. viii. . Colace100 mg ordered one tablet to be administered once a day, not administered on May 5, 2010 at 5:00 PM and noted unavailable from the pharmacy; Lopid 600 mg ordered one tablet to be administered twice a day, not administered on May 5, 2010 at 9:00 AM and 9:00 PM, or May 26, 2010 at 9:00 AM and noted unavailable from the pharmacy; Lactinex one chewable tablet ordered to be administered once a day, not administered on May 5, 2010 at 5:00 PM and noted unavailable from the pharmacy; Megace oral suspension 400 ml /4 ml ordered to be administered once a day, not administered on May 5, 2010 at 9:00 AM and noted unavailable from the pharmacy; Protonix 40 mg ordered to be administered once a day, not administered on May 5, 2010 at 9:00 PM and noted unavailable from the pharmacy; Mirapex 0.125 mg ordered one tablet to be administered once a day, not administered on May 5, 2010 at 9:00PM or May 6, 2010 at 9:60 PM and noted unavailable from the pharmacy; Flomax 0.4 mg ordered one tablet to be administered once a day, not administered on May 5, 2010 at 9:00 PM and noted unavailable from the pharmacy; Hytrin 5 mg ordered one tablet to be administered once a day, not administered on May 5, 2010 at 9:00 PM and noted unavailable from the pharmacy; x. Detrol LA 4 mg ordered one tablet to be administered once a day, not administered on May 5, 2010 at 9:00 AM and noted unavailable from the pharmacy; xi. Effexor XR 37.5 mg ordered one tablet to be administered once a day, not administered on May 5, 2010 at 9:00 AM and noted unavailable from the pharmacy; Commencing May 20, 2010, a physician order required the administration of Hytrin 6 mg one tablet to be administered once a day; The resident’s medication administration record (MAR). reflects that the Hytrin 6 mg was not administered as ordered on May 20, or 21, 2010 at 9:00 PM and noted unavailable from the pharmacy. 12. That Petitioner’s representative interviewed Respondent’s risk manager during the survey regarding the failure to administer prescribed medications as ordered for resident number one (1) and the risk manger indicated as follows: a. The resident’s prescribed medications were delivered from pharmacy the same day that the resident was admitted; Respondent had an agency nurse that sent the medications back to the pharmacy and did not administer the medications; On May 13, 2010Respondent conducted an in-service for nursing staff regarding new admissions of residents as well as all residents receiving their medications in a timely manner as ordered by the physician. 13. - That Petitioner’s representative reviewed the in-service roster of nurses attending the training program and noted as follows: 14. a. Only eight (8) of Respondent’s twenty (20) nursing staff members had attended the in-service program; b. ‘One of the nursing staff members who had failed to administer prescribed medications to resident number one (1) on May 5 and 6, 2010, as above described, and failed to administer prescribed Hytrin 6 mg on May 20 and 21, 2010, was not documented as having attended the medication in-service presentation. That Petitioner’s representative reviewed Respondent’s records related to resident number three (3) and noted as follows: 15. a. The resident’s medication administration record (MAR) indicates the resident is scheduled to receive physician ordered medications starting on February 11, 2010; b. The following prescribed medications were not documented as administered on the following dates: i. Glumetza-I ordered to be administered 1 dose once a day, not administered on February 11, 12, 13, 14, 15, and 16, 2010 at 9:00 AM and noted unavailable from the pharmacy; ii, Lasix 40 mg ordered one tablet to be administered twice a day, not administered on March 2, 2010 at 5:00 PM and noted unavailable from the pharmacy; iii. Megace 10 ml ordered to be administered twice a day, not administered on March 6, 7, and 8, 2010 at 4:30 PM and noted unavailable from the pharmacy. That the above reflects Respondent's failure to ensure that all physicians’ orders are followed as the same relate to the timely acquiring and administering of medications includin; but not limited to where the medications were timely delivered and not provided as prescribed. 16. That said failure is contrary to the requirements of law. 17. That the Agency determined that these failures relate to the operation and maintenance of a facility or to the personal care of residents that indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents cited this deficient practice as an Isolated State Class III deficiency. 18. That Respondent was given a correction date of July 28, 2010. 19. That on or about July 8, 2010, the Agency conducted a revisit to this complaint investigation of Respondent’s facility. 20. That based on observation, the review of records, and interview, Respondent failed to follow physician's orders for acquiring and administering medications for one (1) of six (6) sampled residents, the same being contrary to the minimum requirements of law. 21, That Petitioner’s Representative reviewed Respondent’s records related to resident number one 91) during the survey and noted as follows; a. The resident was admitted to the facility on July 7, 2010 at 1:30PM with a primary diagnosis of gastroenteritis; b. The resident’s medication administration record (MAR) documented that on July 7, 2010 the following medications were ordered: Synthroid 150 mcg | tab daily AC breakfast; Remeron 15 mg 1 tab daily at bedtime (9:00 PM); Duoneb 0.5-2.5 mg/3ml every 6 hours via nebulizer; Effexor XR 150 mg 1 tab daily (9:00 AM); Protonix 40 mg once daily (6:00 AM); Femara 25 mg 1 tab daily (9:00 AM); Toprol XL 100 mg 1 tab daily (9:00 AM); Zocor 40 mg t tab daily (9:00 AM); Agrylin 0.5 mg 1 twice daily (9:00 AM and 9:00 PM); ¢. That none of these medications had not been received or administered to the resident for any prescribed dosage or time by !1:50 PM on July 8, 2010. 22. That Petitioner’s representative interviewed Respondent’s day nurse assigned to resident number one (1) on July 8, 2010 at 10:15 AM who indicated as follows: a. The night nurse had told the her that the medications for the resident had not been delivered to the facility; b. She had called the pharmacy after being informed that the medications were not delivered; c. She was told by the pharmacy that the they had never received the faxed orders from the facility and that she needed to re-fax the orders; d. The fax conformation report dated July 8, 2010 at 7:38 AM revealed that the medication orders for the resident were re-faxed to the pharmacy; e, She stated that the pharmacy stated that the medications would be sent to the facility STAT; f A STAT order is to be delivered within three (3) hours, however the medication stift had not arrived at the time of the interview. 23. That Petitioner’s representative interviewed Respondent’s unit manager regarding resident number one (1) on July 8, 2010 at 10:30 AM who indicated that she had admitted the resident the day before and had faxed the medication orders to the pharmacy, but the was unable to find the fax conformation for the orders. 24. That Petitioner’s representative reviewed of the medical record of resident number one (1) and noted a nursing note dated July 7, 2010 at 1:30 PM that stated "Meds varied and faxed to pharmacy". 25. That Petitioner’s representative interviewed Respondent’s risk manager regarding resident number one (1) on July 8, 2010 at 10:32 AM who indicated as follows: a, The pharmacy makes two daily deliveries, one at 6:00 AM and again at 9:00 PM; b. If medications are not delivered, the nurse on duty is to call the pharmacy and report to them that they did not get all the medications ordered. 26. That Petitioner’s representative reviewed of the medical record of resident number one (1) and could locate no indication that either Respondent’s evening nurse on July 7, 2010 or the night nurse on July 7 -- 8, 2010 had called the pharmacy when the medications did not arrive on the 9:00 PM or 6:00AM deliveries. 27. That Respondent’s unit manager could not produce any communication records of either of the two nurses referenced above calling the pharmacy. 28. That Petitioner’s representative continued to interview Respondent’s day nurse on July 8, 2010 at 11:15 AM who indicated that she did not get any of the medications from the automated medication dispensing unit, or Pyxis, because the mediations for the resident were either not in the Pyxis machine or were not the same dose as the medications in the Pyxis. 29, That Petitioner’s representative reviewed the list of medications contained in the Pyxis and noted that the prescribed medications for resident number one (1), Toprol XL 100 mg 1 tab, Zocor 40 mg 1 tab, and Remeron 15 mg | tab, were listed as being available to be dispensed. 30. That Petitioner’s representative noted that no indication on the medication administration record of resident number one (1) indicated that the above referenced medications were removed from the Pyxis and administered to the resident. 31. That Petitioner’s representative reviewed the Agenda for the Nursing Meeting of June 10, 2010 which reflected as follows: “Nurses re-inserviced on medication delivery/administration in a timely manner. If med ordered not delivered before next scheduled administration time nurses 10 are to a) check pyxis inventory list, located behind the med room doors, to see if medications is usually kept in the pyxis; b) if medication is not available through pyxis, place call to pharmacy in the nurse must then notify the physician that we are unable to obtain this medication and will need a sub (substitute) or an order to hold this medication until available from the pharmacy; d) unit managers/supervisors will routinely review the mar/tar ensure completion". 32. That Petitioner’s representative noted that no indication on the medical record of resident number one (1) reflected that the evening or night nurse had checked the Pyxis, had called the pharmacy to arrange delivery through a local vendor, or had called the physician to obtain direction about the medication until the medication was available from the pharmacy. 33. That Petitioner’s representative interviewed Respondent’s day nurse on July 8, 2010 at 10:15 AM who confirmed that the physician had not been notified that the medications were not available. 34. | That the above reflects Respondent’s failure to ensure that all physician’s orders are followed as the same relate to the timely acquiring and administering of medications including but not limited to where the medications were maintained by the facility and not provided as prescribed, 35, That Respondent had a duty to follow all physician orders as prescribed, and if not followed, to record the reason on the resident’s medical record during that shift. 36. | That Respondent has failed to fulfill this responsibility. 37. That these failures, collectively and individually, constitute intentional or negligent acts that materially affected the health or well being of the resident. 38. That the Agency determined that these failures relate to the operation and maintenance of a facility or to the personal care of residents that indirectly or potentially threaten the physical or emotional health, safety, or security of facility residents cited this deficient practice as an Uncorrected Isolated State Class ITI deficiency. WHEREFORE, the Agency seeks to impose an administrative fine in the amount t of $1,000.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(8)(c), Florida Statutes (2010). COUNT H 39. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Count I of this Complaint as if fully set forth herein. 40. Based upon Respondent’s uncorrected State Class III deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part II of Florida Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(a), Florida Statutes (2010). WHEREFORE, the Agency intends to assign a conditional licensure status to Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(7), Florida Statutes (2010) commencing July 8, 2010 and ending August 16, 2010. Respectfully submitted this 1 day of October, 2010. Thérhds J. Walsh Il, Esquire Bar. No. 566365 gency for Health Care Admin. 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1525 (office) DISPLAY OF LICENSE Pursuant to § 400.23(7)(e), Fla. Stat. (2009), Respondent shall post the most.current license ina. prominent place that is in clear and unobstructed public view, at or near, the place where residents are being admitted to the facility. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent 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 to the attention of: The Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has beeryserved by US. Certified Mail, Return Receipt No: 7004 2890 0000 526 7087 on October D , 2010 to Russell Ward, Administrator, ARC Villages IL, LLC d/b/a Freedom Pointe at the Villages Rehabilitation and Healthcare, 1460 El Camino Real, The Villages, Florida 32159, and by U.S. Mail to C T Corporation System, Registered Agent, ARC Villages IL, LLC d/b/a Freedom Pointe at the Villages Rehabilitation and Healthcare, 1200 South Pine Island Road, Plantation, FL 33324, J. Walsh H, Esquire Russell Ward, Administrator Vi C d/b/a Freedom _____| Pointe at the Villages Rehabilitation and Healthcare 1460 El Camino Real The Villages, Florida 32159 (U.S. Certified Mail) Kris Mennella, Field Office Manager 14101 NW Hwy., 441 Suite 800 Alachua, Florida 332615 (U.S. Mail) C T Corporation System istered Agent, 00 ARC Villages IL, LLC d/b/a Freedom Pointe at the Villages Rehabilitation and Healthcare 1200 South Pine Island Road, Plantation, FL 33324 .S. Mail Thomas J. Walsh II, Esquire Senior Attorney Agency for Health Care Admin. 525 Mirror Lake Dr., N., #330G St. Petersburg, Florida 33701 Interoffice USPS - Lrack & Conlirm Page { or! UNITED STATES POSTAL SERVICE Track & Confirm Search Results Label/Receipt Number: 7004 2890 0000 5526 7087 ~aereraaer Service(s): Certified Mail™ Track & Confirm Status: Delivered Enter LabelReceipt Number. Your item was delivered at 12:41 pm on October 08, 2010 in LADY LAKE, FL 32159. 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Docket for Case No: 10-009850