STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs, Case Nos. 2011006453 2011006454 LAKE WALES HEALTH CARE OPERATIONS COMPANY, d/b/a ASTORIA HEALTH AND REHABILITATION CENTER, 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 Lake Wales Health Operations Company, d/b/a Astoria Health and Rehabilitation Center (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 May 24, 2011 and ending June 24, 2011 and impose an administrative fine in the amount of two thousand dollars ($2,000) based upon Respondent being cited for two uncorrected Class III deficiencies, JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2010). 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 Filed October 17, 2011 3:33 PM Division of Administrative Hearings facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), _ Chapters 400, Part II, and 408, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. ) 4, Respondent operates a 120-bed nursing home, located at 701 Overlook Drive SE, Winter ‘Haven, Florida 33884 and is licensed as a skilled nursing facility license number 130471045. 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(N054) .. 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein, ve That pursuant to Florida law, all licensees of nursing homes facilities shall adoptiand make public a statement of the rights and responsibilities of the residents of such facilities:and shall treat such residents in accordance with the provisions of that statement, The statement-shall assure each resident the right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if available; planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with _ tules as adopted by the agency. § 400.022(1)(1), Fla, Stat. (2010). 8. That pursuant to Florida Jaw, all physician orders shal! be followed as prescribed, and if not followed, the reason shall be recorded on the resident’s medical record during that shift. Fla. Admin, Code R. 59A-4.107(5) ‘9. That on April 14, 2011 the Agency conducted a complaint investigation (CCR#2011003389) of Respondent’s facility. 10. That based upon interview, observation, and the review of records, Respondent failed to follow physician's orders for three (3) of seven (7) residents reviewed, the same being contrary to the mandates of law. 11. That Petitioner’s representative reviewed Respondent’s records related to resident number six (6) during the survey and noted.as follows: a, A physician’s order dated April 9, 2011 prescribes the resident 1V Zosyn 3735 | Grams every eight (8) hours for ten (10) days for a diagnosis of pneumonia. b. The resident’s medication administration record reflects that on April 14, 2011 there was a blank spot for the dose of IV Zosyn. ¢. No reason why the physician’s order was not followed was documented, 12. That Petitioner’s representative interviewed Respondent’s staff nurse number one ‘(1) during the survéy regarding resident number six (6) and the nurse indicated as follows: | a. She did not administer the 1:00 a.m. IV antibiotic that was due for the resident ‘° ) because she was not IV certified. . b. She had to wait until the registered nurse came in at 5:00 a.m. and the antibiotic would still be several hours late. ) 13. That Petitioner’s representative interviewed Respondent’s wound care nurse at 8:20 a.m: ee on April 14, 2011 who indicated as follows: a. When the nurses have IVs they cannot give, they will cal] her and let her know what needs to be given. b. She comes in and gives it whenever it needs to be given. c. She was not called and did not give the IV antibiotic to resident number six 960 because no one asked her to give it. d. She stated she did not know that the staff on that night was not IV certified. 14. That Petitioner’s representative interviewed Respondent’s Director of Nursing (DON) ' duiing the survey regarding resident number six (6) and the DON indicated as follows: a. Staff nurse number one (1) could have called the DON or unit manager to administer the medication. b. All the nurses know the DON can be called when needed. 15. That Petitioner’s representative reviewed Respondent’s records related to resident number seven (7) during the survey and noted as follows: a, A physician's order of April 6, 2011 at 11:20 p.m. prescribed for the resident Vancomycin 750mg once every twenty-four (24) hours for a chest wall infection, b, The resident’s medication administration record documents that on April 7, 2011, the.0900 dose was not given, c. A-nurse's note documents on April 7, 2011 at 4:23 p.m. that the medication had not. yet been received from pharmacy and a call was placed to the pharmacy for Stat order, . ‘d. The first dose of the prescribed Vancomycin was given to the resident at 0900 on 4/8/11, thirty-four (34) houts after the initial order. 16. That Petitioner’s representative reviewed Respondent’s records related to resident number five (5) during the survey and noted as follows: a. 2011 to Robert Aller ‘Broome, Administrator, Astoria Health and Rehabilitation Center, 701 Overlook: ’ Drive SE, Winter Haven, FL 33884, and by U.S. Mail to Samuel A. Houghton, 500 S Florida Avenue, Suite 800, Lakeland, FL 33801. rfas J. Walsh, Il, Esquire Copy furnished to: Pat Caufman, FOM Robert Allen Broome, Administratot lAstoria Health and Rehabilitation Winter Haven, FL 33884 7003 1010 O00D 4745 - Bt

Docket for Case No: 11-005328

Issue Date	Proceedings
Nov. 29, 2011	Settlement Agreement filed.
Nov. 29, 2011	(Agency) Final Order filed.
Nov. 15, 2011	Order Relinquishing Jurisdiction and Closing File. CASE CLOSED.
Nov. 14, 2011	Motion to Relinquish Jurisdiction filed.
Oct. 21, 2011	Response to Initial Order filed.
Oct. 18, 2011	Initial Order.
Oct. 17, 2011	Notice (of Agency referral) filed.
Oct. 17, 2011	Amended Petition for Formal Hearing filed.
Oct. 17, 2011	Administrative Complaint filed.

Orders for Case No: 11-005328

Issue Date	Document	Summary
Nov. 28, 2011	Agency Final Order