STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2009003679 AHCA No.: 2009003680 Vv. , Return Receipt Requested: 7008 0500 0002 0764 8643 SOVEREIGN HEALTHCARE OF BOYNTON 7008 0500 0002 0764 8650 BEACH, LLC d/b/a BOYNTON BEACH REHABILITATION CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency for Health Care Administration. (hereinafter “AHCA”), by and through the undersigned counsel, and files this administrative complaint against Sovereign Healthcare of Boynton Beach, LLC d/b/a Boynton Beach Rehabilitation Center (hereinafter “Boynton Beach Rehabilitation Center”) pursuant to Chapter 400, Part II and Section 120-60, Florida Statutes, (2008) hereinafter alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $2,500.00 pursuant to Sections 400.23(8) (b), Florida Statutes (2008), [AHCA No.: 2009003679]. Filed June 10, 2009 10:05 AM Division of Administrative Hearings. 2. This is an action to impose a conditional licensure rating pursuant to Section 400.23(7) (b), Florida Statutes (2008), [AHCA No. 2009003680]. JURISDICTION AND VENUE 3. This court has jurisdiction pursuant to Section 120.569 and 120.57, Florida Statutes (2008), and Chapter 28-106, Florida Administrative Code. 4. Venue lies pursuant to Section 120.57, Florida Statutes (2008), and Rule 28-106.207, Florida Administrative Code (2008). PARTIES 5. AHCA is the regulatory authority with regard to skilled nursing facilities licensure pursuant to Chapter 400, Part II, Florida Statutes (2008), and Rule. 5S9A-4, Florida Administrative Code. 6. Boynton Beach Rehabilitation Center operates a 168-bed nursing home located at 9600 Lawrence Road, Boynton Beach, Florida 33436. Boynton Beach Rehabilitation Center is licensed as a skilled nursing facility under license number 14590961. Boynton Beach Rehabilitation Center was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I BOYNTON BEACH REHABILITATION CENTER FAILED TO PROVIDE ADEQUATE CARE IN ACCORDANCE WITH THE PLAN OF CARE. SECTION 400.022(1) (1), FLORIDA STATUTES {ADEQUATE AND APPROPRIATE HEALTH CARE STANDARDS) CLASS II 7. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 8. Boynton Beach Rehabilitation Center was cited with one (1) Class II deficiency as a result of a licensure survey conducted on March 6, 2009. 9. A licensure survey was conducted on March 20, 2007. Based on record review and interview, it was determined that the facilitate failed to provide for 1 of 40 résidents sampled for record review the adequate and appropriate care in accordance with the comprehensive assessment and plan of care related to Coumadin administration and monitoring for Resident #486. The findings include the following. 10. Review of Resident #486's clinical record on 3/04/09, at 8:30 AM, revealed that the resident was admitted to the facility on 2/06/09 with diagnoses including Poisoning- Anticoagulants, Joint replacement Knee, Anemia, Aftercare Joint Replace and Atrial fibrillation. 1. The resident's clinical record contained the following physician's orders: . a. On 2/11/09 for "PT/INR every Monday and Thursday. Call if INR is above 3.5. Hold coumadin. Change coumadin to 3.5 mg qd." . b. On 2/19/09 "Stat PT/INR. If INR (greater than) >10 send to ER, if (less than) <10, do daily PT/INR." -and Cc. On 2/19/09, "Send to hospital for level, Tx (evaluation and treatment) ." 12. The clinical record included information from the hospital that stated the resident was admitted to the hospital from the facility with Coumadin toxicity on 2/19/09 and the resident received 3 units of fresh frozen plasma at the hospital and returned to the facility on 2/23/09. 13. Further review of the resident's clinical record on 3/04/09, at 9:08 AM revealed the following labs: a. 2/07/09 - PT/INR, results showed 21.6/1.8. According to the lab ranges, the PT was high and the INR was low (ranges 2.0-3.0). The labs had a handwritten note that stated, "Faxed to Dr. (name) 6:25 PM, 2/7/09. Called- pending call back". b, 2/09/09 - PT/INT, results showed 23.2/2.0. According to the lab ranges, the INT was within limits and the PT was high (range 12.8-15.2). Cc. 2/12/09 - BMP, CBC, and PT/INR. The lab results show that the resident had low potassium, low calcium, and low RBC, HGB, HCT. The PT/INR results were 35.8/3.4 (normal ranges 12.8-15.2/2.0-3.0). The results had a handwritten note for "Coumadin 3.5 mg po qd." and "40 meq po Q4 hours X 3 doses repeat once dose completed." d. 2/14/09 - BMP, CBC, Diff, Platelet Count - the results showed that the resident had high glucose, low RBC, HGB, HCT and Lymphocytes and high granulocytes. The results had a handwritten note that stated they had been faxed to the physician. e. 2/19/09 - PL/INR 89.6/10.7 - very high. There were had written notes , "Vit K 5 mg SQ now, Stat PT/INR, if INR >10 send to ER>" The stat PT/INR showed the following results: 86.6/10.2. 14. The clinical record was missing PT/INR results for 2/16/09. 15. The resident's clinical record contained a care plan dated 2/24/09 for "risk for active bleeding r/t use of anticoagulant meds." The resident's initial care plan, dated 2/06/09, included interventions for the risks associated with the use of Coumadin. The interventions included the administration of the medication and scheduling of lab tests as ordered by the physician. They also called for staff to notify the physician of abnormal lab results. 16. A review of a calendar revealed Mondays in February 2009 fell on 2/9, 2/16, and 2/23 and Thursdays on 2/12, 2/19, and 2/26. 17. Further review of the resident's clinical record on 3/04/09, revealed a nursing note dated 2/16/09, at 12:10 PM, that stated, "Critical PT/INR called into Dr. (name)'s office. PT 49.7/INR 5.1, awaiting call back." 18. The nursing notes and the rest of the resident's clinical record failed to record if staff received a call back from the physician and if staff further attempted to contact the physician. 19. Review of the February 2009 MAR revealed that staff continued to administer the Coumadin even when the 2/16/09 to 2/18/09 PT/INR results were high. 20. In an interview on 3/04/09, at 9:49 AM, the Unit Manager reviewed the resident's clinical record and_ the facility's lab book regarding the 2/16/09 missing lab results. The lab book recorded the resident had PT/INR labs. ordered on 2/16/09. 21. %In a subsequent interview on 3/04/09 at 10:01 AM, the Unit Manager provided the faxed PT/INR results for 2/16/09. They were consistent with the nursing note of 2/16/09. 22. In an interview conducted with the Clinical Coordinator, on 10:03 AM at 3/04/09 in the Unit Manager's presence, the Coordinator stated that she wrote the order of 2/16/09. She reviewed the resident's clinical record, acknowledged that there were no new orders regarding Coumadin on 2/16/09 and that on 2/16/09, if she did not get a call back from the physician, she must have passed in on to the next shift. 23. The Unit Manager provided a copy of the policy for anticoagulant use on 3/04/09, at approximately 10:15 AM. Review of the policy revealed that it called for staff to "Initiate and order anticoagulant therapy labs per physician's order" and "If lab results exceed therapeutic ranges, ‘Hold! anticoagulant medications until physician has been notified and new order is veceived.". 24. Interview with DON 3/04/09 11:45 AM, the DON reviewed the chart and acknowledged that the resident's February 2009 MAR showed staff gave the resident the Coumadin on 2/16, 2/17 and 2/18/09. She also acknowledged that the resident went out on the 2/19/09 to the hospital. 25. Interview with the resident's physician on 3/04/09, at 4:33 PM, the physician reported that he is very careful with Coumadin doses. He stated that the used Coumadin for A-fib for the resident. He stated that he regulate the Coumadin levels by monitoring the PT/INR. He stated that he was extra cautious and ordered levels to be checked twice a week, even if the resident stable. His policy when the INR is between 5 and 10, would be to watch it carefully. 26. The physician further reported that he has his cell phone with him at every facility and that he gave the DON his telephone number. He stated that he returns telephone calls. 27. Based on the foregoing facts, Boynton Beach Rehabilitation Center violated Section 022(1) (1), Florida Statutes, herein classified as an isolated Class II violation pursuant to Section 400.23(8), Florida Statutes (2008), which carries an assessed fine of $2,500.00. This also gives rise to conditional licensure status pursuant to Section 400.23(7) (b), Florida Statutes (2008). DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes (2008), Boynton Beach Rehabilitation Center shall post the licensé in a prominent place that is clear and unobstructed public view at or near the place where residents are being admitted to the facility. The conditional License is attached hereto as Exhibit “A” EXHIBIT “A” Conditional License License # SNF14590961; Certificate No.: Effective date: 03/06/2009 Expiration date: 09/30/2010 Standard License License # SNF14590961; Certificate No.: Effective date: 04/16/2009 Expiration date: 09/30/2010 15698 15699 PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: 1. Make factual and legal findings in favor of the Agency on Count I. 2. Assess against Boynton Beach Rehabilitation Center an administrative fine of $2,500.00 for the violation cited above. 3. Assess against Boynton Beach Rehabilitation Center a conditional license in accordance with Section 400.23(7), Florida Statutes. 4. Assess costs related to the investigation and prosecution of this matter, if applicable. ‘Se Grant such other relief as the court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2008). Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the Agency for Health Care Administration and delivered to the Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. ll RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE A REQUEST A HEARING WITHIN TWENTY~ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Ir YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER ‘ Qthas _ Ko Alba M. Rodfiguez, Es Fla. Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Arlene Mayo-Davis Field Office Manager Agency for Health Care Administration $150 Linton Blvd. — Suite 500 Delray Beach, Florida 33483 (U.S. Mail) Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 ' (Interoffice Mail) Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Daniel Benson, Administrator, Boynton Beach Rehabilitation Center, 9600 Lawrence Road, Boynton Beach, Florida 33436; National Corporate Research, Ltd., Inc., 515 &. Park Avenue, Tallahassee, Florida 32301 on this 19% aay of You _» 2009. Othe ; Alba M. Rodriguez, Esq. 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Also complete A pluitp item 4 if Restricted Delivery Is desired. {ff ff /y Gragent @ Print your name and address on the reverse , , ‘ 4. Ly, DAIL [2 Addressee So that we can return the card to you. B, Recalved by ( Printed Nir E @ Attach this card to the back of the mallpiece, Nr io my ©. Pale of Dalive or on the front If space permits. 4 Ch a oe 1. Article Addressed tor D. Is delivery address different from item 17 Ye If YES, enter delivery address below: No RoXisined. Corporate Covwnch. Ate 515 E. Pork, Anents Fadlo harman. Fdouddes i240 Cortiled Fea Fleturn Receipt Fes. {Endorsement Required) Resirloted Delivery Feo (Endorsement Required) 3. Service Type } O Certified Mall (1 Express Mail ' 0 Registered C1 Return Receipt for Merchandise O Insured Mat = 1.6.0.0, Aap 7008 OS00 O02 O7b4 BSD seq nies 2 orPO Bo ND. Ea, * came r from service fabel) 7008 O500 5002 O?bY BbSo PS Form 3811, February 2004 Domestic Return Recelpt 102595-02-M-1840 ;

Docket for Case No: 09-003090

Orders for Case No: 09-003090