L8-/ 787 STATE OF FLORIDA FILED AGENCY FOR HEALTH CARE ADMINISTRATION APR 8 02 STATE OF FLORIDA AHCA AGENCY FOR HEALTH DEPARTMENT CLERK CARE ADMINISTRATION, Petitioner, AHCA NO: 2001064231 vs. 08-01-0302 HEALTHPARK CARE CENTER, INC., D/B/A HEALTHPARK CARE CENTER Respondent. ADMINISTRATIVE COMPLAINT co 36 HY 8- AH 20 COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Healthpark Care Center, Inc., d/b/a Healthpark Care Center (hereinafter “Respondent” ) and alleges: NATURE OF THE ACTION 1. This is an action to impose two (2) administrative fines in the amount of two thousand five hundred ($2,500) dollars each pursuant to Section 400.23 Florida Statutes. Jurisdiction 2. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. 3. Venue lies in Lee County, Division of Administrative Hearings, pursuant to 120.57 Florida Statutes, and Chapter 28 F.A.C. Parties 4. AHCA, is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part II, Florida Statutes and Rules 59A-4, Florida Administrative Code. 5. Respondent, Healthpark Care Center, Inc., d/b/a Healthpark Care Center, is a nursing home located at 16131 Roserush Court, Fort Myers, Florida 33908. The facility is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I RESPONDENT FAILED TO DEVELOP AND IMPLEMENT WRITTEN POLICIES AND PROCEDURES THAT PROHIBIT NEGLECT OF RESIDENTS Rule 59A-4.1288, F.A.C. (adopting by reference 42 CFR 483.13 (c) (1) (i)) CLASS II DEFICIENCY 6. AHCA re-alleges and incorporates (1) through (4) as if fully set forth herein. 7. Based upon the Annual Health and Recertification and Licensure Survey conducted on 10/15/01 - 10/18/01, it was determined that the facility failed to provide toileting needs as care planned for 1 (Resident #10) of 8 sampled residents reviewed for incontinence and toileting programs. The resident was not toileted for more than 5 hours causing multiple creased areas and redness to her left groin, perineum and buttocks. The findings include: a. On 10/15/2001, Resident #10 was in her room, #141, in bed A at 2:20 P.M. Resident stated she was wet. The call bell cord was clipped to the sheet, but the bell mechanism was off the side of the bed, out of the resident's reach. Surveyor walked to the North nurse's station and continued to observe the resident's room entrance. Record review revealed Resident #10's most recent quarterly Minimum Data Set (MDS) completed 8/27/2001, assessed her with bladder incontinence at 3 (frequently incontinent), bowel incontinence at 1 (less than once weekly), activity is assessed as bed mobility 3/3 (needs extensive assistance to move in bed), and toilet use at 3/2 (needs extensive assistance). At 4:15 P.M., the resident requested the surveyor to get someone to change her as no one had come in and the call bell was still out of her reach. The resident's request was given to the nurse at 4:20 P.M. b. On 10/16/01, Resident #10 was observed up in her wheelchair in the hall outside her room from 8:55 A.M. until 12:05 P.M., when she was escorted to the main dining room. At 2:20 P.M., resident was still sitting in her wheelchair. After surveyor intervention, the CNA put the resident to bed at 2:30 P.M. When the adult diaper was removed, it revealed the resident to be incontinent of feces and urine. The odor of urine was very strong in the room. The resident's perineum and buttocks were red and moist, with multiple creased areas. The left groin was especially red. During an interview with the CNA, she stated the resident was last toileted before lunch at approximately 11:00 A.M. This was during the time of direct observation by the surveyor of the resident in the hall outside her room. This made it impossible for the resident to have been changed at 11:00 a.m. Review of resident's Care Plan revealed that she was to have the call bell in place at all times and scheduled toileting. 8. The Respondent was given written notification of the cited deficiency and the time frame for correction. 9. Based on the foregoing, Respondent violated Rule 59A-4.1288 F.A.C. adopting by reference 42 CFR 483.13 (c) (1) (i). This is a class II violation and the Agency is authorized to impose the fine amount of $2,500.00 pursuant to Section 400.23 (8) (b) Florida Statutes. COUNT II RESPONDENT FAILED TO ENSURE THAT A RESIDENT MAINTAINS ACCEPTABLE PARAMETERS OF NUTRITIONAL STATUS, SUCH AS BODY WEIGHT AND PROTEIN LEVELS 59A-4.1288, F.A.C. (adopting by reference 42 CFR 483.25(i) (1)) CLASS II DEFICIENCY 10. AHCA re-alleges and incorporates (1) through (4) as if fully set forth herein. 11. Based upon the Annual Health and Recertification and Licensure Survey conducted on 10/15/01 - 10/18/01, it was determined that the facility failed to adequately assess and revise the care plan to address the significant weight loss of 1 (Resident #17) of 15 from a sample of 21 residents reviewed for nutritional concerns. This is evidenced by: 1) After Resident #17 had a significant weight loss of 6.8% in 4 weeks, the facility did not have an adequate nutritional assessment and did not revise the care plan to prevent the resident from further weight loss. The findings include: Resident #17 was admitted to the facility on 9/6/01 with diagnoses that include Sepsis, S/P Incision and Drainage (I&D) of the Right Knee and GI Bleed. The resident has a history of Coronary Artery Disease (CAD) . During the clinical record review, it revealed that the resident's physician ordered Ancef (antibiotic) 2 grams every 8 hours on 9/6/01, to be given for 25 days. During the review of the resident's initial MDS (Minimum Data Set) completed on 9/19/01, it revealed he weighed 185 lbs (pounds) and is 72 inches tall. Review of the MDS also revealed the resident is independent with his cognitive skills for daily decision making. Further review of the MDS also revealed he requires set up and supervision during meals. He requires extensive assistance with dressing, bathing, and ambulation. Review of the nutritional assessment revealed the RD assessed the resident on 9/10/01. The assessment stated, "Resident has decreased appetite which may be R/T (related to) current meds (medications); Resident's wife feels he has lost wt (weight) but wt is increased due to edema in feet. Resident's current diet meets assessed needs. Will include food preferences to increase intake." Under "Ethnic/Religious Food Preferences" it stated, "No cultural preferences stated." The nutritional assessment completed by the RD on 9/10/01, stated that the resident weighs 185 ibs. His UBW (usual body weight) is 182 lbs. During an interview with the Unit Manager and Registered Dietitian (RD) on 10/18/01 at approximately 11:00 AM, they stated that the resident's weight of 185 lbs., which is documented in the initial MDS, was inaccurate. The resident's accurate weight on admission was 175 lbs. During the review of the weight record, it revealed the resident remained 175 lbs. on 9/11/01. On 9/18/01, the resident weighed 168 lbs., indicating a weight loss of 7 lbs. in 7 days. During the review of the Resident Assessment Protocol (RAP) completed on 9/19/01, it revealed she triggered for "Nutritional Status." The care plan developed on 9/19/01 stated, "Res. (resident) leaves 25% or more of food uneaten at most meals. Weight: 168 lbs; UBW (usual body weight) 182 lbs." The goal stated, "Res will maintain weight up or down within 1-2 lbs. through next quarter: 10/17/01." The following approaches are listed: - "Diet as ordered." - "Encourage fluids.” - "Monitor weights." - "Pood preferences and substitute for uneaten foods." - "Assist with tray set-ups, open all packages." Review of the physician's order dated 9/18/01, revealed the resident was started on TwoCal HN (supplements) 60 cc's four times a day, ice cream everyday at 8:00 P.M., fruit everyday at 10:00 A.M. and peanut butter, cracker, and juice everyday at 2:00 P.M. During the review of the Medication Administration Record (MAR) for the months of 9/01 and 10/01, it confirmed that this additional supplements were given to the resident, however there is no documentation to indicate the resident's consumption of each supplement. Interview with the Unit Manager on 10/18/01 at approximately 11:15 A.M., also confirmed there is no documentation in the clinical record to indicate the resident's consumption of each snack. Review of the CNA (Certified Nursing Assistant) Care Plan for the month of 9/01, revealed no documentation being offered at bedtime and no documentation for the month of 10/01 that the resident received bedtime snacks, Further review of the resident's weight record revealed the resident weighed 163 lbs on 10/2/01. This indicates a significant weight loss of 12 lbs or 6.8% of his total body weight in 4 weeks. Review of the nurses! notes revealed that this significant weight loss had been identified on 9/26/01, 20 days after the resident's admission to the facility. The nurse's notes dated 9/26/01, stated that the care plan to address the risk for weight loss was reviewed. Review of the care plan confirmed it was reviewed on 9/26/01 and 10/6/01. The goal stated, "Will lose no more weight, 11/6/01." Added to approaches stated, "Nutritional supplements as ordered." However, further review of the clinical record and the care plan revealed no documentation to indicate that a comprehensive nutritional assessment was done. There is no documentation in the resident's clinical record to indicate that the care plan was revised. During an interview with the Unit Manager on 10/18/01 at approximately 2:15 P.M., she confirmed that after the resident's admission to the facility on 9/6/01, the resident was refusing to eat, but his appetite improved in the beginning of 10/01. He was consuming 75% - 100% of his meals. She also stated that the resident had, "pedal (foot and ankle) edema” on admission to the facility. There is no documentation in the resident's clinical record to indicate that this edema was monitored. There is no documentation in the clinical record that the resident was on a diuretic. She further stated that the final report on the blood culture done on the resident, dated 10/1/01, was positive for Candida sp (yeast infection). During the review of the clinical record, it did not have documentation to indicate that an assessment of the resident's protein intake was assessed at this time. There is no documentation in the resident's clinical record to indicate that the resident's albumin and protein levels were assessed. During an interview with the Unit Manager on 10/18/01, at approximately 2:15 P.M., she stated that the resident's family members were encouraged to visit more often and encourage to bring foods that he likes. She stated that the resident liked Italian food. ‘This is contrary to the RD's nutritional assessment completed on 9/10/01. She also stated that the facility staff continued to honor resident's food preferences and provided alternatives. There is no documentation in the resident's clinical record to indicate that an assessment of the resident's nutritional status, based on his current weight of 163 lbs. and current food intake was done. Further review of the resident's weight record revealed he weighed 158 lbs. on 0/9/01. This reveals a weight loss of 5 more lbs. in 12 days. During the interview on 10/18/01 at approximately 2:15 P.M., she did not have an explanation why the resident continued to lose weight despite an improvement in his appetite. 12. The Respondent was given written notification of the cited deficiency and the time frame for correction. 13. Based on the foregoing, Respondent violated 59~A- 4.1288 F.A.C. adopting by reference 42 CFR 483.25(i) (1). This is a class II violation and the Agency is authorized to impose the fine amount of $2,500.00 pursuant to Section 400.23 (8) (b) Florida Statutes. WHEREFORE, AHCA intends to impose two (2) fines against Respondent in the amount of two thousand five hundred ($2500.00) dollars each for a total of five thousand ($5000) dollars for the above-stated violations pursuant to Section 400.23 (8) (b) Florida Statutes. 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 and explained in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 525 Mirror Lake Drive, St. Petersburg, Florida, 33701; Dennis L. Godfrey, Senior Attorney. 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. Respectfully Submitted, nnis Lv Godfrey Senior Attorney FBN: 0158100 Agency for Health Care Administration 925 Mirror Lake Dr. St. Petersburg, FL 33701 (727) 552-1525 I HEREBY CERTIFY that a true copy hereof has been sent by U.S. Certified Mail Return Receipt No. 7001 2510 0007 5976 5513, to Robert C. McCurdy, Registered Agent for Healthpark Care Center, Inc., 2776 Cleveland Avenue, Ft. Myers, FL 33901, and by U.S. Mail, first class postage prepaid, to Mr. Douglas J. Potts, Administrator, Healthpark Care Center, 16131 Roserush Court, Fort Myers, FL 33908, on this / JH aay of March, 2002. fnis L. Godfrey Copies furnished to: Robert C. McCurdy, Registered Agent for Healthpark Care Center, Inc. 2776 Cleveland Avenue Ft. Myers, FL 33902 (U.S. Certified Mail) Mr. Douglas J. Potts, Administrator, Healthpark Care Center, 16131 Roserush Court, Fort Myers, FL 33908 (U.S. Mail) Dennis L. Godfrey, Esquire AHCA - Senior Attorney 525 Mirror Lake Drive North, St. Petersburg, Florida 33701

Docket for Case No: 02-001788

Orders for Case No: 02-001788