Certified Article Number 7 4 4575 1294 2049 aSb9 SENDERS RECORD STATE OF FLORIDA ‘ AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, © 3 vs. AHCA No. 2004006444. =, “tv a es HARBOUR HEALTH SYSTEMS, 4 LLC d/bla HARBOUR HEALTH CENTER, .f a Respondent. ee ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA” or “Agency’"), by and through the undersigned counsel, and files this Administrative Complaint against HARBOUR HEALTH SYSTEMS, LLC d/b/a HARBOUR HEALTH CENTER (“Respondent”), pursuant to Sections 120.569, and 120.57, Florida Statutes, and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500), upon Respondent, pursuant to Section 400.23(8)(b), Florida Statutes. JURISDICTION AND VENUE 2. The Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. Administrative Complaint 2004006444 Certified Number 7106 4575 1294 2049 8569 Page 1 of 10 PARTIES 4. AHCA is the regulatory agency responsible for licensure of nursing homes and enforcement of all 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); Chapter 400, Part Il, Florida Statutes, and; Chapter 59A-4 Fla. Admin. Code, respectively. 5. Respondent, HARBOUR HEALTH SYSTEMS, LLC, owns and operates a skilled nursing facility in the state of Florida. The facility, HARBOUR HEALTH CENTER (‘Facility’), is a 120-bed nursing home located at 23013 Westchester Boulevard, Port Charlotte, Florida 33980. Respondent is licensed as a skilled nursing facility, having been issued license #SNF 1504096, effective September 1, 2001. Respondent was at all times material hereto, a licensed facility under the licensing authority of AHCA, and was required to comply with all applicable regulations, statutes and rules. COUNT CLASS II ISOLATED VIOLATION FOR FAILURE TO PROVIDE NECESSARY CARE AND SERVICES 42 CFR 483.25 Section 400.23(8)(b), Florida Statutes Rule 59A-4.106(4)(aa), Fla. Admin. Code Rule 59A-4.1288, Fla. Admin. Code 6. AHCA re-alleges and incorporates by reference paragraphs (1) through (5) above as if fully set forth herein. 7. The regulatory provisions of the Code of Federal Regulations that are pertinent to this alleged violation, read as follows: 42 CFR 483.25 Quality of care. Administrative Complaint 2004006444 Certified Number 7106 4575 1294 2049 8569 Page 2 of 10 7. The regulatory provisions of the Code of Federal Regulations that , are pertinent to this alleged violation, read as follows: 42 CFR 483.25 Quality of care. Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well- being, in accordance with the comprehensive assessment and plan of care. 59A-4.106 Facility Policies. et (4) Each facility shall maintain policies and procedures in the following areas: (aa) Specialized rehabilitative and restorative services. 8. AHCA surveyors conducted an annual survey of Respondent's facility on or about June 17, 2004, which revealed the following: The facility failed to assure that 1 (Resident #16) of 21 active sampled residents received the necessary care and service to prevent and/or treat pain in order for the resident to attain and maintain her highest practicable physical and mental well being; and the facility failed to ensure communication between the facility and outside agencies providing services for 1 resident (Resident #1 0) to attain and maintain their highest practicable physical and mental well being. This is evidenced by; 4) Resident #16 demonstrating pain during a treatment and not receiving pain medication as ordered; 2) No interdisciplinary care plan between Hospice and the facility, and a delay in receiving treatment for an eye infection resulted due to tack of communication between Hospice and the nursing department for Resident #10; 3) Resident #8 injuring foot by cast friction and facility did not implement interventions to prevent re-injury. Specific findings were: a). Review of the medical record for Resident #16 reveals the resident was readmitted to the facility on 5/24/04 with a terminal diagnosis of end stage Chronic Obstructive Pulmonary Disease (COPD) and is to receive Hospice care. Review of physician's order dated 5/27/04 reveals the resident is a DNR (Do Not Resuscitate), DNT (Do Not Transfer) and Comfort measures. Observation on 6/17/04 at 9:30 A.M. revealed Resident #16 was sitting up ina chair in her room. The facility wound care nurse and two CNAs were present. The resident grimaced and said, "Oh, Oh!" when the sweater was removed from her left arm. Two CNAs transferred the resident into bed and placed her on her left side so the wound care nurse could do a treatment. The resident grimaced and cried, "Oh!" several times during the transfer. After the treatment was completed the resident was placed on her back and covered with the blanket. A CNA stated, "Are you OK?” The resident stated, "Not bad." After the CNA left the room she confirmed the resident had stated; “Not bad," when asked if she was OK. Review of the Resident's physician orders reveal the resident is to receive Roxanol 5mg every 2 hours PRN (when necessary) for pain or air hunger. Administrative Complaint 2004006444 Certified Number 7106 4575 1294 2049 8569 Page 3 of 10 b). Review of the clinical record for Resident #10 reveals the resident has a terminal diagnosis and is receiving Hospice services. The resident has Diagnoses that include, but are not limited to Alzheimer Disease, Coronary artery Disease and Failure to Thrive. Review of the Hospice notes reveal! a Hospice nurse is visiting the resident once a week and a Hospice Home Health aide (HHA) is visiting twice a week. Review of the resident's medical record reveals there is no documentation of what services the Hospice nurse and HHA provide. Review of the Resident's Care Plan dated 6/8/04 reveals there is no interdisciplinary care plan to address what services Hospice will provide and how they will coordinate with the facility. During interview on 6/15/04 at 12:20 P.M. the Hospice Registered Nurse stated that she attends the facility care plan meetings and the Hospice care plans are located at the Hospice office. She confirmed that the Resident's care plan did not include any interventions or services that Hospice is providing and that there was a possibility that services could be duplicated. She also stated that she informs the Unit Manager of any problems she finds when she visits. The Hospice Social Worker who was also present for the interview stated, "The Hospice care plans were taken off the charts because they don't always match the facility care plan.” The Hospice Dietitian stated, "I see, Ideally there would be one care plan that included the Hospice care plan.” Review of a Hospice note dated 5/17/04 written by the Hospice nurse reveals the resident has drainage from the Right eye. Review of the facility's nurses notes reveal no documentation of the drainage from the right eye until 6/3/04 when the physician is contacted. Interview with the MDS/Care Plan Coordinator on 6/16/04 at approximately 2:05 P.M. reveals she did not know the Resident's eye had had drainage in May. Review of the facility's 24 hour report for May 2004 reveals no documentation of the right eye drainage for Resident #10. The MDS/Care Plan Coordinator stated she does not always read the Hospice notes but relies on the nurse to inform her of any problems. A laboratory report received 6/5/04 reveals the Resident has an eye infection with Methicillin Resistant Staphylococcus Aureus (MRSA). No treatment was ordered for the eye infection until 6/14/04. c). Resident #8 was re-admitted to the facility on 3/31/04 with diagnosis including tib-fib fracture, that occurred as a result of an accident during transfer on 3/25/04. Review of the Nurse's notes dated 4/28/04 revealed that occurrence type: abrasion Left inner aspect of ankle. Equip Involved: resident has cast on right lower extremity, which appears to have scraped the inner ankle of left lower extremity. Observation on 6/14/04 at 2:20 P.M. found that Resident #8 was lying in a darkened room with covers on. The resident stated she had a cast on her leg and pulled off the covers to show the surveyor a cast on her left lower leg. There was no heel protector on the right foot. ; Observation on 6/14/04 at 5:50 P.M. while sitting in the main dining room in her wheelchair, Resident had a black boot on her left foot that had a cast on it. The right foot had a sneaker on. During the meal, the resident crossed her legs rubbing the left leg onto the right foot. Observation by a nurse surveyor on 6/16/04 at 9 AM., revealed that Resident #8 was in bed with both legs flat on the mattress; the left leg was leaning against the right leg; left ankle on the interior on the bone had a scabbed over area from pressure of the cast Administrative Complaint 2004006444 Certified Number 7106 4575 1294 2049 8569 Page 4 of 10 against the area. There was no pillow between the resident's legs and no heel boots on. A heel boot was folded and placed under the covers to the left of the left leg at the end of the bed. Review of the accident/incident report dated 4/28/04 the RN (Register Nurse) night supervisor assessed the resident's leg as having a 2.5 cm dry abrasion on the inner aspect of the left ankle. Interview with the DON and ADON on 6/16/04 at 9:50 A.M. revealed that the "abrasion" noted on the left ankle occurred because the resident "refuses and kicks boots off." The ADON was asked what was done to prevent the development of the pressure sore and how it was unavoidable. The ADON stated it was an abrasion, and was not a pressure sore. The ADON stated, "I'll get someone else to talk to you about the difference of an abrasion and a pressure sore.” Surveyor asked for the facility policy and procedures for pressure sores. At 10:30 A.M. on 6/16/04 the MDS coordinator brought the surveyor the definitions of abrasion and pressure sore according to the MDS manual. She stated "pressure sores are not usually caused by friction," and that's why she felt it was not coded as a pressure sore. Review of the quarterly MDS revealed she did not code the resident as having a pressure sore acquired in the facility. Review of the resident's care plans revealed on 4/29/04 the care plan for potential for impairment of skin integrity was undated to reflect an Abrasion to the left ankle. The goal was not updated since 3/27/04, before the abrasion was noted. The goal at that time was no skin breakdown. The only approach update was to pad the cast, the approach has no date. No interventions were put in place to care for the abrasion (pressure sore) and how to prevent it from re-occurring. Review of the physician orders revealed on 4/29/04 there as an order to protect area on left inner ankle while right lower extremity cast is on. : During an interview with the day supervisor on 6/17/04 at 12:05 P.M. when asked what the difference between a pressure sore and an abrasion was, she stated, "A pressure sore is over a bony prominence that has continuous pressure on it, such as sitting on your coccyx. She stated a pressure sore is not caused by friction.” During an interview with a family member on 6/17/04 at approximately 10 A.M., the resident's husband stated that, “Most of the times, the staff don't put her booties on her right foot. | find them put away in the closet." After several requests, the facility provided the surveyor with the Pressure Ulcer Treatment policy on 6/17/04 at 2 P.M. It states, “ 2. Determine the ulcer's current stage of development: Stage II Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater. The facility did not identify Resident #8's abrasion as a pressure sore and did not put any interventions in place to prevent it from re-occurring. Administrative Complaint 2004006444 Certified Number 7106 4575 1294 2049 8569 Page 5 of 10 9. Respondent's failure to provide necessary care and services is a violation of Rule 59A-4.1288, Fla. Admin. Code, which incorporates by reference 42 CFR 483.25. 40. | Respondent's failure to provide necessary care and services is a violation of Rule 59A-4.106(4)(aa), Fla. Admin. Code. 11. AHCA classified the nature and scope of this violation as a class Il “isolated” violation. Pursuant to Section 400.23(8)(b), this classification constitutes grounds for the imposition of an administrative fine of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500). A class II violation is defined as one that “the agency determines has compromised the resident's ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services.” CLAIM FOR RELIEF WHEREFORE, the Agency respectfully requests the following relief: 1. Factual and legal findings in favor of the Agency on Count I. 2. Imposition of an administrative of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500). 3. Such other relief as this Court deems is just and proper. NOTICE Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569 and 120.57, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights Administrative Complaint 2004006444 Certified Number 7106 4575 1294 2049 8569 Page 6 of 10 (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to: Agency Clerk Agency for Health Care Administration Building 3, MSC #3, 2727 Mahan Drive Tallahassee, Florida, 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE AGENCY MUST RECEIVE A REQUEST FOR HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT BY RESPONDENT. FAILURE TO COMPLY WILL CONSTITUTE AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND RESULT IN THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted this (7 dayof__Neves Ler: 2004. Eric Bredemeyer, Esquire Assistant General’Counsel Fla. Bar No. 318442 Agency for Health Care Administration 2295 Victoria Avenue Room 346C Ft. Myers, Florida 33901 (239) 338-3203 (office) (239) 338-2372 (fax) CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint, with an Election of Rights for Administrative Hearing form and an Explanation of Rights Under Section 120.569, F.S.A. form, have been forwarded by certified mail, return receipt requested, to: H. Bowen Administrative Complaint 2004006444 Certified Number 7106 4575 1294 2049 8569 Page 7 of 10 Gillespie, Administrator, Harbour Health Center, 23013 Westchester Boulevard, Port Charlotte, Florida 33980, this /P_dayof___ Novetn ber 2004, “a ~ <—~—. i waa reat Esa —) Administrative Complaint 2004006444 Certified Number 7106 4575 1294 2049 8569 Page 8 of 10

Docket for Case No: 04-004635

Orders for Case No: 04-004635