02-004418 Agency For Health Care Administration vs. Woodland Field, Inc. Status: Closed Recommended Order on Thursday, May 29, 2003.

Summary: Evidence showed one uncorrected Class III deficiency; no medication training using state-approved curriculum; $500 fine.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Petitioner, )

)

vs. ) Case No. 02 - 4418

)

WOODLAND FIELD, INC., )

)

Respondent. )

)

RECOMMENDED ORDER

A formal hearing was conducted in this case on February 20,

2003, in Jacksonville, Florida, before the Division of

Administrative Hearings by its Administrative Law Judge, Diane

Cleavinger.

APPEARANCES

For Petitioner: Michael O. Mathis, Esquire

Agenc y for Health Care Administration

2727 Mahan Drive

Fort Knox Building Three, Suite 3431

Tallahassee, Florida 32308

For Respondent: Harriett Wallace, Administrator

Woodland Field, Inc.

8236 Moncrief - Dinsmore Road

Jacksonville, Florida 32219

STATEMENT OF THE ISSUE

The issue for consideration in this proceeding is whether

Respondent's license as an adult living facility should be

disciplined.

PRELIMINARY STATEMENT

The Agency for Health Care Administration (AHCA or

Petitioner) filed an Ad ministrative Complaint against

Respondent, Woodland Field, Inc. (Respondent), an assisted

living facility, located at 8236 Moncrief - Dinsmore Road,

Jacksonville, Florida. The Administrative Complaint alleged

that Respondent violated Sections 400.423(3) and 400.452(5),

Florida Statutes; and Rules 58A - 5.0191(4)(a)4 and

58A - 5.0191(4)(c), Florida Administrative Code, by failing to

ensure that a staff member trained in first - aid and CPR was in

the facility at all times when residents were present; fai ling

to maintain a written work schedule that reflects the facility's

24 - hour staffing pattern for a given time period; and failing to

ensure that an unlicensed person providing assistance with

self - administered medications received the required minimum

o f 24 hours of training prior to assisting with such

medications.

Respondent filed a petition for a formal administrative

hearing. The petition was forwarded to the Division of

Administrative Hearings .

At the hearing, AHCA presented the testimony of thre e

witnesses and offered 15 exhibits into evidence. Respondent

presented the testimony of one witness and offered one composite

exhibit into evidence.

FINDINGS OF FACT

1. Respondent, Woodland Field, Inc., holds a license to

operate an adult living facil ity (ALF) effective December 8,

2001, through December 7, 2003. Respondent is a small ALF. In

addition to the administrator/owner, Respondent employs two

staff persons to assist the residents of the ALF.

2. On June 7, 2002, AHCA conducted a survey of

R espondent's facility. The facility's administrator was not

present when the surveyors arrived. There was one person, Lisa

Phoenix, on duty at the facility when the survey began. The

person on duty was assisting with self - administered medication.

She ha d some medication training but did not have the four hours

of training required pursuant to Section 400.2456, Florida

Statutes (2002). Several violations were found during the

survey.

3. The violations relevant here were that the duty person

at the tim e did not have documentation or training in first - aid

and CPR (Tag A525); there was no posted staffing schedule for

the facility available for review (Tag A528); and the person on

duty at the time did not have medication training as required by

Florida Sta tutes (Tag A1106). All four citations were

classified as Class III deficiencies.

4. The violations were to be corrected immediately and,

but for the posting of a schedule satisfactory to AHCA, the

violations were corrected by Respondent.

5. On July 23, 2002, a follow - up visit and moratorium

visit was conducted by AHCA. Again, there was one person,

Ronella Jones, on duty at the facility. Ms. Jones had had

first - aid and CPR training in the past but her documentation of

such training had expired prior to the July 23, 2002, survey.

While at the facility, the surveyor did review what he described

as a sheet of paper, titled, "work schedule" dated March 1,

2002. However, the surveyor felt that not enough information

was contained on the schedule to enab le it to comply with

Rule 58A - 5.0191(4)(c), Florida Administrative Code. The

surveyor cited three uncorrected deficiencies, related to Tags

A525 (first - aid training), A528 (work schedule), and A1106

(medication training).

6. On July 24, 2002, AHCA recei ved a copy of the expired

first - aid card for Ms. Jones from Petitioner. The card was

later updated and the technical deficiency timely corrected.

AHCA also received a copy of Ms. Jones' medication training

certificate. The certificate was dated July 8, 2002, prior to

the survey and signed by Erma Thompson, R.N. The certificate

was not in Respondent's files because it had not been received

by the facility at the time of the July survey. Additionally,

AHCA received a copy of a generic work schedule for P etitioner's

facility. Petitioner had also faxed a similar schedule to AHCA

in June. The work schedule was dated March 1, 2002. It did not

reflect a specific time period that the schedule would be

effective. However, given the size of the facility, it i s

reasonable to conclude that the schedule was effective until

changed. The schedule also did not list the names of individual

staff. The schedule looked as follows:

WORK SCHEDULE

Weekly Schedule

Staff on Duty 6:00 a.m. 6:00 p.m.

Staff on Duty 6:00 p.m. 6:00 a.m.

Weekends

(Staff will alternate)

Staff on Duty 6:00 a.m. 6:00 p.m.

Staff on Duty 6:00 p.m. 6:00 a.m.

The generic schedule, while not listing specific individuals,

does reflect the general staffing pattern of Respondent since it

shows the time periods during which staff will be on duty at the

facility and a reasonable person can determine the scheduling

pattern for staff therefrom.

7. Copies of similar schedules were submitted into

evidence with names of facility employees hand - writte n on these

schedules. However, the relation of these schedules to one

another or anything about them regarding their development was

not shown by the evidence, except that since Respondent’s

facility was very small, scheduling of specific employees was

ac complished on a more or less ad hoc basis.

8. Because, Ms. Jones indicated to AHCA surveyors that she

had not received any medication training, the surveyors

questioned the authenticity of Ms. Jones' medication training

card .

9. On August 12, 2002, Erma Thompson, R.N., mailed AHCA a

letter referencing the medication training she gave to

Respondent's staff. Although the communication is somewhat

non - specific as to when Nurse Thompson performed such training

or to when she trained Respondent’s staff, the evidence showed

that Nurse Thompson's communication was in reference to the

on - going surveys of Petitioner's facility and the training of

Ms. Jones and Ms. Phoenix.

10. On August 23, 2002, AHCA conducted a third follow - up

visit and moratorium monitorin g visit of Respondent's facility.

11. The surveyor found that Tags A528 (work schedule) and

A1106 (medication training) were not corrected.

12. Both employees of Respondent had medication training

certificates. As indicated earlier, the certificate for

Ms. Jones was dated July 7, 2002, and signed by Erma

Thompson, R.N. However, Petitioner had continued to question

the validity of Ms. Jones' medication training. Therefore,

Respondent sent AHCA a copy of the administrative guide used as

a curriculum for training its employees. The curriculum was

dated September 1992. Unfortunately, the curriculum was out of

date as of 1999 when the only official and required curriculum

changed. The 1992 requirements for medication training differed

somewhat from the st ate’s current requirements for medication

training.

13. The evidence did not demonstrate the extent of the

differences between the two curriculums. However, they were

different, and the older version used by Nurse Thompson was not

the version recognized b y Petitioner as the curriculum meeting

its rule on medication training. Ms. Phoenix's medication

training certificate was dated March 27, 2002, and was signed by

an L.P.N. The course was given by Nurse Thompson, who was

an R.N. The same nurse/L.P.N. who had signed the facility's

administrator's certification had signed Ms. Phoenix’s

medication training card. The facility administrator met all of

Respondent's certification requirements. The Rule does not

specifically require that the medication training card be signed

by the R.N. giving the course. Therefore, as long as an R.N.

teaches the course the training is valid. However, as indicated

earlier, the curriculum used by Nurse Thompson in her training

was out of date for Ms. Phoenix, as well. Therefo re,

technically, even though Respondent had made a good faith effort

to comply with the Rule’s medication training requirements,

Tag A528 remained uncorrected.

14. During the August 23, 2002, survey, there was a

schedule available for review at the facili ty. The schedule was

the generic work schedule similar to the schedule noted above.

It did not have the employees who would be on duty at a given

time. However, it did reflect the staffing pattern of

Respondent's facility. The evidence was clear that R espondent's

administrator/owner was confused as to what information the

surveyors wanted on the facility's work schedule since this

generic schedule reflected staffing patterns; there were only

two employees other than herself at the facility, and the

admi nistrator desired to maintain flexibility in utilizing those

employees. Further, the surveyors' complaints about the

schedule were at best de minimus , given the size of the facility

involved.

15. On September 5, 2002, a fourth moratorium monitoring

visit was conducted at Respondent's facility. Again, the

facility was cited for Tag A528 (work schedule) and Tag A1106

(medication training).

16. On October 3, 2002, AHCA conducted a fifth follow - up

visit and moratorium monitoring visit. The same citations we re

given. The surveyor was able to review a work schedule similar

to the generic work schedule noted above. However, the document

was dated September 5, 2002. A paragraph was added listing the

names of the administrator and her two employees and indicat es

they will be assigned on an ad hoc basis. The work schedule

also indicates the staff signs in daily with specific hours and

personnel listed on the daily time sheet. Again the facility

was cited for Tag A528 (work schedule) and Tag A1106 (medication

t raining). The schedule complied with the requirements of

Rule 59A - 0191(4)(c), Florida Administrative Code. However,

neither employee’s medication training had been updated under

the current curriculum. Therefore, the deficiency related to

the medication training of Respondent’s employee’s remained

uncorrected.

CONCLUSIONS OF LAW

17. The Division of Administrative Hearings has

jurisdiction over the parties to and the subject matter of this

proceeding. Section 120.57(1), Florida Statutes.

18. Tag A525 i s based on Rule 58A - 5.0191(4)(a), Florida

Administrative Code. The Rule requires that at least one staff

member who is trained in first - aid and CPR, shall be within the

facility at all times when residents are in the facility. See

also Rule 58A - 5.0191(4) , Florida Administrative Code. The

deficiency was timely corrected.

19. Tag A528 is based on Rule 58A - 5.0191(4)(c), Florida

Administrative Code. The Rule states that the facility shall

maintain a written schedule which reflects the facility's

24 - hou r staffing pattern for a given time period. Importantly,

for purposes of analyzing the language of Rule 58A - 5.0191(4)(c),

Florida Administrative Code, the Rule requires facilities larger

than Petitioner's to maintain time sheets for all staff.

Rule 58A - 0 19(4)(c), Florida Administrative Code, only requires a

generic schedule which functions as a model for how staff will

be scheduled and maintained by the facility; the Rule does not

require specific staff be listed such as would be listed on a

time sheet. The Rule only requires that the pattern of staffing

be reflected by the schedule. Therefore, the generic schedule

of Respondent complied with the Rule. The deficiency was timely

corrected after the first survey and remained corrected

thereafter.

20. Tag A1106 relates to Section 400.452(5), Florida

Statutes, and Rule 58A - 5.0191(5), Florida Administrative Code.

Section 400.452(5), Florida Statutes (2002), and the Rule

requires unlicensed staff involved with the management of

medications and assisting with the self - administration of

medications under Section 400.4256, Florida Statutes, must

complete a minimum of four hours of training pursuant to a

curriculum developed by the department and provided by a

registered nurse, licensed pharmacist or department s taff.

Rule 58A - 5.0191(5), Florida Administrative Code, states:

(5) ASSISTANCE WITH SELF - ADMINISTERED

MEDICATION AND MEDICATION MANAGEMENT.

Unlicensed persons who will be providing

assistance with self - administered

medications as described in Rule 58A - 5. 0185,

F.A.C., must receive a minimum of 4 hours of

training prior to assuming this

responsibility. Courses provided in

fulfilment [sic] of this requirement must

meet the following criteria:

(a) Training must cover state law and rule

requirements with res pect to the

supervision, assistance, administration, and

management of medications in assisted living

facilities; procedures and techniques for

assisting the resident with self -

administration of medication including how

to read a prescription label; provid ing the

right medications to the right resident;

common medications; the importance of taking

medications as prescribed; recognition of

side effects and adverse reactions and

procedures to follow when residents appear

to be experiencing side effects and ad verse

reactions; documentation and record keeping;

and medication storage and disposal.

Training shall include demonstrations of

proper techniques and provide opportunities

for hands - on learning through practice

exercises.

(b) The training must be provide d by a

registered nurse, licensed pharmacist, or

department staff who shall issue a training

certificate to a trainee who demonstrates an

ability to:

1. Understand a prescription label;

2. Provide assistance with self -

administration in accordance with Se ction

400.4256, F.S., and Rule 58A - 5.0185, F.A.C.,

including:

a. Assist with oral dosage forms, topical

dosage forms, and topical ophthalmic, otic

and nasal dosage forms;

b. Measure liquid medications, break scored

tablets, and crush tablets in accordanc e

with prescription directions;

c. Recognize the need to obtain

clarification of an "as needed" prescription

order;

d. Recognize a medication order which

requires judgement or discretion, and to

advise the resident, resident’s health care

provider or fac ility employer of inability

to assist in the administration of such

orders;

e. Complete a medication observation

record;

f. Retrieve and store medication; and

g. Recognize the general signs of adverse

reactions to medications and report such

reactions.

The evidence did not demonstrate that the out - of - date curriculum

complied with the Rule's criteria for medication training.

Therefore, the training received by Respondent’s employees did

not comply with the current medication training requirement of

the Rule. The deficiency was not timely corrected and,

therefore, is subject to an administrative fine.

21. Section 400.419(1)(c), Florida Statutes (2002),

requires that Class III violations are those conditions or

occurrences related to the operation mainte nance of a facility

or to the personal care of residents which the agency determines

indirectly or potentially threaten the physical or emotional

health, safety, or security of facility residents, other than

Class I or Class II violations. A Class III vio lation is

subject to an administrative fine or not less than $500 and not

exceeding $1,000 for each violation. A citation for a Class III

violation must specify the time within which the violation is

required to be corrected. If a Class III violation is corrected

within the time specified, no fine may be imposed, unless it is

a repeated offense. In this case, Respondent made good faith

attempts to comply with the medication training requirement and

did provide some training, which while out of date, had been

approved previously by Petitioner. Given this effort, a fine of

$500.00 is reasonable.

RECOMMENDATION

Based on the foregoing Findings of Facts and Conclusions of

Law, it is

RECOMMENDED:

That the Agency for Health Care Administration enter a

final order imposing a fine of $500.00 for one uncorrected

deficiency related to medication training.

DONE AND ENTERED this 29th day of May, 2003, in

Tallahassee, Leon County, Florida.

___________________________________

DIANE CLEAVINGER

Administrative Law Judg e

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675 SUNCOM 278 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearin gs

this 29th day of May, 2003.

COPIES FURNISHED :

Michael O. Mathis, Esquire

Agency for Health Care Administration

2727 Mahan Drive

Fort Knox Building Three, Suite 3431

Tallahassee, Florida 32308

Harriett Wallace, Administrator

Woodland Field, Inc.

8236 Moncrief - Dinsmore Road

Jacksonville, Florida 32219

Lealand McCharen, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

Valda Clark Christian, General Counsel

Agency for Health Care Administrat ion

2727 Mahan Drive

Fort Knox Building, Suite 3431

Tallahassee, Florida 32308

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this Recommended Order. Any exceptions

to this Recommended Order should be filed with the agency that

will issue the final order in this case.