STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, ys. : Case Nos. 2011014103 ORANGE PARK FACILITY OPERATIONS, LLC d/b/a CONSULATE HEALTH CARE OF ORANGE PARK, 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 Orange Park Facility Operations, LLC, d/b/a Consulate Health Care of Orange Park (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2011), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of $5,000.00 upon Respondent, pursuant to Section 400,23(8), Florida Statutes (2011).The imposition of this fine is based on two (2) Class II deficiencies, The Agency also intends to impose a Conditional rating effective October 28, 2011, pursuant to §400.23(7), Florida Statutes (2011). JURISDICTION AND VENUE lL, The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (201 1). 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. Filed July 13, 2012 1:27 PM Division of Administrative Hearings 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 facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4. Respondent operates a 120-bed nursing home, located at 1215 Kingsley Avenue, Orange Park, Florida 32073, and is licensed as a skilled nursing facility license number 1016095. 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 J (Tag N216) . 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That pursuant to §400.102(1), Florida Statutes (2010), Florida law states: In addition to the grounds listed in part II of chapter 408, any of the following conditions shall be grounds for action by the agency against a licensee: (1) An intentional or negligent act materially affecting the health or safety of residents of the facility. 8. That from October 24, 2011 through October 28, 2011, the Agency conducted an unannounced licensure survey at the Respondent’s facility. 9. Based on observation, resident and staff interview, and clinical record review, the facility failed to ensure that 2 (Resident #109, and #110) of 40 sampled residents were free from mistreatment by other another resident. 10. The failure to prevent mistreatment resulted in actual mental harm to Resident #109 and Resident #110. 11. On 10/24/11 at 1:20 PM during an interview with Resident #109, her roommate, Resident #67, walked over to Resident #109's side of the room and stated that Resident #109 talked too much and began pointing and yelling at Resident #109. Resident #109 revealed that Resident #67 always exhibited this behavior when she (Resident #109) had visitors or staff with her. Resident #67 yelled at Resident #109 to shut up. Then Resident #109 yelled back at Resident #67 for her to shut-up. 12, An interview on 10/24/11 at 1:30 PM with Registered Nurse (RN) #1 revealed that Resident #67 had been relocated within the facility because of issues with the former roommate. RN #1 revealed that Resident #67 had told her that Resident #109 talked too much. RN #1 indicated that Resident #67 liked her room quiet and Resident #109 liked to talk. 13, On 10/24/11 at 1:36 PM an interview was conducted with the Social Worker (SW). The SW revealed that Resident #67 was moved from her previous room, because she was agitated when the staff went into the room to provide care to the roommate. Per the SW Resident #67 would yell at staff and "run the staff out". . 14, On 10/24/11 at 1:50 PM an interview with Resident #109 revealed that Resident #67 had told her to shut up on more than one occasion. She stated that every time she had a visitor Resident #67 would get upset, because they were not there to see her. She stated that her visitors had to go to the nurses’ station and be escorted to her room because of Resident #67's behavior. Resident #109 revealed that the staff got on to her (Resident #109) for yelling back at Resident #67. 15. On 10/24/11 at 2:13 PM an interview with certified nursing assistant (CNA) #1 revealed she was aware Resident #67 did not like anyone in her room for any reason. CNA #1 revealed that if the CNAs are talking or if they close the door Resident #67 gets upset and had used profanity. CNA #1 stated that the roommates were face to face yelling at each other one day and the staff had to calm them down. CNA #1 indicated that this concern had been reported to the nurses. 16. An interview with CNA #2 on 10/24/11 at 2:15 PM revealed that Resident #67 spoke Italian and spoke very little English. She stated that she had never observed the two roommates . yelling at each other. But states that the pair had gotten "a little antsy" with each other but it was "nothing of concern." CNA #2 stated that Resident #67 gets upset when Resident #109 talks loud. She stated that Resident #109 was hard of hearing and talked loud. The CNA stated that she whispers in Resident #109's ear and talked to her quietly so they would not disturb Resident #67, 17, An interview with CNA #3 on 10/24/11 at 3:00 PM revealed that Resident #67 had been confrontational with staff in the past. She stated that Resident #67 had also gotten on to her one day for closing the door to her room when she was providing the roommate with personal care. CNA #3 stated that the nursing staff was aware of Resident #67's behavior. 18. An interview with CNA #4 on 10/26/11 at 7:25 AM revealed that she had been employed with the facility for almost two years, and she worked on the night shift. She revealed that Resident #67 could be erratic and almost everything disturbed her. For example, passing ice and getting her roommate dressed. She stated that Resident #67's behaviors included throwing things and yelling. She stated that the behavior occurred, "mostly in the early morning." CNA #4 revealed that nursing staff had been notified, and that "sometimes they could hear." 19. On 10/26/11 at 3:45 PM an interview with CNA #5 revealed that Resident #67 and Resident #109 “had been having issues for months." 20. A staff interview with the Unit Manager (UM) on the GNR Unit on 10/27/11 at3:10 PM revealed that Resident #67 had been on the GNR Unit for a couple of months. The UM stated that Resident #67 was moved to a different room because she was having behavior issues. She stated that Resident #67 would yell at her previous roommate in Italian, and then get up and turn off the roommate's television. She stated that the roommate’s family would observe Resident #67 get up and turn off the television. The UM stated that Resident #67 yelled at her roommate because of the TV, and about her space issue. The UM also stated that Resident #67 would block the entrance of her room, because she did not like staff going through her space to attend to her roommate. The UM also revealed that Resident #67 did not like staff closing the door when they cared for her roommate as well. 21 ; On 10/27/11 at 3:36 PM an interview with the director of nursing revealed that she was aware Resident #67 had a history of behaviors and yelling out at staff. 22. Areview of Resident #67's clinical record revealed the resident was admitted to the facilityon 07/12/11. The nursing notes revealed on 7/17/11 at 4:00 AM the resident called for the nurse every time the roommate tured on the television. On 7/24/11 at 11:00 PM the nurse indicated'that Resident #67 became agitated when staff cared for her roommate. The nurse indicated that Resident #67 threw belongings and yelled at her roommate. The note indicated that Resident #67 was placed on 1:1 care. On 7/25/11 at 2:00 AM the nurse indicated that the resident was throwing her belongings when staff cared for her roommate and 1:1 care was provided. 23. Clinical record review revealed Resident #67 had a Behavioral Management Care Plan completed on 07/26/11. The problem listed for the care plan was socially inappropriate behaviors. The inappropriate behavior listed was throwing things and verbally abusive as indicated by screaming. The care plan goal was that resident would not throw items at staff and would not verbally threaten others on a daily basis. This care plan was updated on 10/24/11 to include the problem that the resident was yelling at roommate and agitation. 24. The clinical record revealed an additional Behavioral Management Care Plan completed ) on 10/14/11 for the problem of the resident resisting care related to activities of daily living , (ADL)/showers, verbally abusive as identified as screaming at roommates, and physically inappropriate as identified as throwing objects at staff. The goals identified for each problem listed was that the resident would not demonstrate the behaviors on a daily basis. There was no evidence this care plan had been revised or updated since it was implemented on 10/14/11. 25. A review of Resident #67's quarterly Minimum Data Set assessment, with an assessment reference date of 10/16/11 revealed in Section E, Behavior was coded as "2" meaning that the behaviors (physical behavioral symptoms directed towards others (i.e. hitting, kicking, pushing, scratching, grabbing); verbal behavioral symptoms directed towards others (i.e. threatening others, screaming at others, cursing at others) occurred 4 to 6 days but less than daily. . 26. A review of the social services notes in Resident #67's clinical record dated 07/22/11 Resident #67 spoke to the SW regarding a room change. The resident was advised that no beds were available at that time, but she would offer one when it became available. On 07/24/ 11 the SW spoke with the resident's daughter regarding a room change. She was told that no room was available, but would offer the change when one became available. On 07/25/11 the SW notes tevealed that Resident #67 spoke with the SW to request aroom change. Resident #67 complained to SW that she was "not able to sleep because people are coming in her room to care for her roommate all day and all night. She complained TV being up loud." The next entry in the SW notes was dated 10/25/11. The note was regarding the 10/24/11 incident when Resident #67 yelled at her roommate, as witnessed by the Agency for Health Care Administration (AHCA) surveyor. 27. A review of the facility's Resident to Resident Abuse Policy and Procedure with an, effective date of 01/07 revealed that "residents must not be subjected to abuse by anyone, including but not limited to facility staff, other residents, consultants or volunteers, staff of other agencies serving the individual, family members or legal guardians, friends or other individuals....Abuse means the willful inflection of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, or pain, or mental anguish, or * deprivation. by an individual, including a caretaker, of goods and services that are necessary to attain or maintain physical, mental, and psychosocial well-being." The protocol included in the Resident Abuse Policy and Procedure with an effective date of 01/07 revealed in the protocol included "remove the residents from danger immediately; if applicable, move the resident causing the danger to another room or unit, pending investigation of the incident; closely monitor and document the behavior and condition of the residents involved to evaluate for any injury and to prevent recurrence of the incident; the facility must develop measures to prevent reoccurrence and document these measure in the resident's medical record to include revision of the plan of care." 28. = On 10/25/11 at 8:35 AM with Resident #110 revealed she had an issue with her roommate Resident #97. The interview revealed that Resident #97 was no longer residing in the facility. Resident #110 stated that she had attended a cookie decorating activity the day before, but when she returned to her room there were about 10 -12 cookies there. Resident #110 stated that she thought someone was just kidding with her, so she took the cookies to the staff to distribute. Resident #110 stated that when Resident #97 returnéd to the room and realized the cookies were gone she became very upset. Resident #110 stated that Resident #97 carried on for a while and the facility eventually transferred Resident #97 out of the facility via stretcher. 29. Resident #110 revealed that she had been having issues with Resident #97 since the resident was admitted to the room about a week ago. Per Resident #110 revealed that Resident #97 was "very bossy, it disturbed her to be disturbed, it was terrible. I thought I can't hand 1e this. She was in here only about a week. I didn't let the staff know. But when I had to use the bathroom, the staff was taking me down to where you get the showers, not to disturb the roommate." Resident #110 revealed that the staff was taking her to the shower room to also get her dressed. "I didn't like that. She had gotten dangerous. I was afraid. They took her out of here last night. I had my first good night sleep last night since she came." 30. A review of Resident #97s clinical record revealed that the resident was sent to the hospital for an involuntary examination (Baker Act) on 10/24/11. The Baker Act documentation revealed that Resident #97s mental illness diagnoses was a long history of Bipolar disorder, Depression, Anxiety Disorder, and Insomnia. 31. The supporting documentation revealed Resident #97 had made statements of wanting to die, uncooperative with staff attempts to work with her, made threats to all roommates in the past week with daily behavior escalating and was refusing medications. Other information relied upon to determine the need for Baker Act included, but was not limited to Resident #97 being agitated, refusing care, and threatening other residents; a long term Bipolar disorder with worsening symptoms and risk to self and others escalating; and other residents are stating they are afraid of Resident #97. 32. A review of the doctor’s progress note dated 10/18/11 revealed that Resident #97 had progressive depression and was becoming increasingly agitated, and that there were many issues with all her perspective roommates. 33. A nurse's note dated 10/21/11 at 12:30 PM revealed that Resident #97 was very agitated and was verbally abusive to staff and roommate and had also threatened her roommate. 34. A weekly progress note dated 10/22/11 revealed that Resident #97 was agitated and verbally abusive to staff and to Resident #110 on 10/21/11. 35. A nurse’s note dated 10/21/11 at 5:30 PM revealed that Resident # 110 was afraid of Resident #97, and that she had cursed at her and had become very agitated. 36. Class “II” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines directly threaten the physical or emotional health, safety, or security of the clients, other than class I violations. The,agency shall impose an administrative fine as provided by law for a cited class II violation. A fine shall be levied notwithstanding the correction of the violation. §408.813(2)(b), Florida Statutes (2011) 37. Acclass II deficiency is a deficiency 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. A class II deficiency is subject to a civil penalty of $2,500 for an isolated deficiency, $5,000.for a patterned deficiency, and $7,500 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class II deficiencies during the last licensure inspection or any inspection or complaint investigation since the last licensure inspection. A fine shall be levied notwithstanding the correction of the deficiency. $400.23(8)(b), Florida Statutes (2011) 38. . The Agency cited Respondent for an isolated Class II deficiency. 39. The Agency gave a mandatory correction date of this deficiency of November 28, 2011, WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,500 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §400.23(8)(b), Florida Statutes (2011). COUNT II (Tag N906) 40. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if Fully set forth herein. 41. That pursuant to §400.147(1), Florida Statutes (2011), (1) Every facility shall, as part of its administrative functions, establish an internal risk management and quality assurance program, the purpose of which is to assess resident care practices; review facility quality indicators, facility incident reports, deficiencies cited by the agency, and resident grievances; and develop plans of action to correct and respond quickly to identified quality deficiencies. The program must include: (e) The development of appropriate measures to minimize the risk of adverse incidents to residents, including, but not limited to, education and training in risk management and risk prevention for all nonphysician personnel, as follows: 1... Such education and training of all nonphysician personnel must be part of their initial orientation; and 2. At least 1 hour of such education and training must be provided annually for al} ' nonphysician personnel of the licensed facility working in clinical areas and providing resident care. 42. That from October 24, 2011 through October 28, 2011, the Agency conducted an unannounced licensure survey at the Respondent’s facility. 43. Based on observation, resident and staff interview, and medical record review, the facility 10 failed to implement policies and procedure to ensure that 2 (Resident #109 and #110) of 40 sampled residents were free from mistreatment from another resident. Failure to implement the facility's policies and procedures resulted in actual mental harm and anguish for Resident #109 and #110. 44, On 10/24/11 at 1:20 PM during an interview with Resident #109, her roommate, Resident #67, walked over to Resident #109's side of the room and stated that Resident #109 talked too much and began pointing and yelling at Resident #109. Resident #109 revealed that Resident #67 always exhibited this behavior when she (Resident #109) had visitors or staff with her. Resident #67 yelled at Resident #109 to shut up. Then Resident #109 yelled back at Resident #67 for her to shut-up. 45. An interview on 10/24/11 at 1:30 PM with Registered Nurse (RN) #1 revealed that Resident #67 had been relocated within the facility because of issues with the former roommate. RN #1 revealed that Resident #67 had told her that Resident #109 talked too much. RN #1 indicated that Resident #67 liked her room quiet and Resident #109 liked to talk. 46. On 10/24/11 at 1:36 PM an interview was conducted with the Social Worker (SW). The SW revealed that Resident #67 was moved from her previous room, because she was agitated when the staff went into the room to provide care to the roommate. Per the SW Resident #67 would yell at staff and "run the staff out". 47. On 10/24/11 at 1:50 PM an interview with Resident #109 revealed that Resident #67 had told her to shut up on more than one occasion. She stated that every time she had a visitor Resident #67 would get upset, because they were not there to see her. She stated that her visitors had to go to the nurses station and be escorted to her room because of Resident #67's behavior. Resident #109 revealed that the staff got on to her (Resident #109) for yelling back at Resident ist #67. 48. On 10/24/ 11 at 2:13 PM an interview with certified nursing assistant (CNA) #1 revealed she was aware Resident #67 did not like anyone in her room for any reason. CNA #1 revealed that if the CNAs are talking or if they close the door Resident #67 gets upset and had used profanity. CNA #1 stated that the roommates were face to face yelling at each other one day and the staff had to calm them down. CNA #1 indicated that this concern had been reported to the nurses. 49, An interview with CNA #2 on 10/24/11 at 2:15 PM revealed that Resident #67 spoke Italian and spoke very little English. She stated that she had never observed the two roommates yelling at each other. But states that the pair had gotten "a little antsy" with each other but it was "nothing of concern." CNA #2 stated that Resident #67 gets upset when Resident #109 talks . loud. She stated that Resident #109 was hard of hearing and talked loud. The CNA stated that she whispers in Resident #109's ear and talked to her quietly so they would not disturb Resident #67. . 50. An interview with CNA #3 on 10/24/11 at 3:00 PM revealed that Resident #67 had been confrontational with staff in the past. She stated that Resident #67 had also gotten on to her one day for closing the door to her room when she was providing the roommate with personal care. CNA #3 stated that the nursing staff was aware of Resident #67's behavior. 51. An interview with CNA #4 on 10/26/11 at 7:25 AM revealed that she had been employed with the facility for almost two years, and she worked on the night shift. She revealed that. Resident #67 could be erratic and almost everything disturbed her. For example, passing ice and getting her roommate dressed. She stated that Resident #67's behaviors included throwing things and yelling. She stated that the behavior occurred, "mostly in the early morning.” CNA #4 12 revealed that nursing staff had been notified, and that "sometimes they could hear.” 52.. On 10/26/11 at 3:45 PM an interview with CNA #5 revealed that Resident #67 and. Resident #109 "had been having issues for months." 53. - Astaff interview with the Unit Manager (UM) on the GNR Unit on 10/27/11 at 3:10 PM revealed that Resident #67 had been on the GNR Unit for a couple of months. The UM stated that Resident #67 was moved to a different room because she was having behavior issues. She "stated that Resident #67 would yell at her previous roommate in Italian, and then get up and turn off the roommate's television. She stated that the roommates family would observe Resident #67 get up and turn off the television. The UM stated that Resident #67 yelled at her roommate because of the TV, and about her space issue. The UM also stated that Resident #67 would block the entrance of her room, because she did not like staff going through her space to attend to her roommate. The UM also revealed that Resident #67 did not like staff closing the door when they cared for her roommate as well. 54. On 10/27/11 at 3:36 PM an interview with the director of nursing revealed that she was aware Resident #67 had a history of behaviors and yelling out at staff. 55. Areview of Resident #67's clinical record revealed the resident was admitted to the facility on 07/12/11. The nursing notes revealed on 7/17/11 at 4:00 AM the resident called for the nurse every time the roommate tured on the television. On 7/24/11 at 11:00 PM the nurse indicated that Resident #67 became agitated when staff cared for her roommate. The nurse indicated that Resident #67 threw belongings and yelled at her roommate. The note indicated that Resident #67 was placed on 1:1 care. On 7/25/11 at 2:00 AM the nurse indicated that the resident was throwing her belongings when staff cared for her roommate and 1:1 care was provided. 56. Clinical record review revealed Resident #67 had a Behavioral Management Care Plan, completed on 07/26/11. The problem listed for the care plan was socially inappropriate behaviors. The inappropriate behavior listed was throwing things and verbally abusive as indicated by screaming. The care plan goal was that resident would not throw items at staff and would not verbally threaten others on a daily basis. This care plan was updated on 10/24/11 to include the problem that the resident was yelling at roommate and agitation. 57. . The clinical record revealed an additional Behavioral Management Care Plan completed on 10/14/11 for the problem of the resident resisting care related to activities of daily living (ADL)/showers, verbally abusive as identified as screaming at roommates, and physically inappropriate as identified as throwing objects at staff. The goals identified for each problem listed was that the resident would not demonstrate the behaviors on a daily basis. There was no evidence this care plan had been revised or updated since it was implemented on 10/14/11. 58. A-review of Resident #67's quarterly Minimum Data Set assessment, with an assessment reference date of 10/16/11 revealed in Section E, Behavior was coded as "2" meaning that the behaviors (physical behavioral symptoms directed towards others (i.e. hitting, kicking, pushing, scratching, grabbing); verbal behavioral symptoms directed towards others (i.e. threatening others, screaming at others, cursing at others) occurred 4 to 6 days but less than daily. 59.. A review of the social services notes in Resident #67's clinical record dated 07/22/11 Resident #67 spoke to the SW regarding a room change. The resident was advised that no beds were available at that time, but she would offer one when it became available. On 07/24/11 the SW spoke with the resident's daughter regarding a room change. She was told that no room was available, but would offer the change when one became available. On 07/25/11 the SW notes revealed that Resident #67 spoke with the SW to request a room change. Resident #67 14 complained to SW that she was "not able to sleep because people are coming in her room to care for her roommate all day and all night. She complained TV being up loud." The next entry in the SW notes was dated 10/25/11. The note was regarding the 10/24/11 incident when Resident #67 yelled at her roommate, as witnessed by the Agency for Health Care Administration (AHCA) surveyor. ) 60. Areview of the facility's Resident to Resident Abuse Policy and Procedure with an effective date of 01/07 revealed that "residents must not be subjected to abuse by anyone, including but not limited to facility staff, other residents, consultants or volunteers, staff of other agencies serving the individual, family members or legal guardians, friends or other individuals....Abuse means the willful inflection of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, or pain, or mental anguish, or deprivation by an individual, including a caretaker, of goods and services that are necessary to attain or maintain physical, mental, and psychosocial well-being." The protocol included in the Resident Abuse Policy and Procedure with an effective date of 01/07 revealed in the protocol included "remove the residents from danger immediately; if applicable, move the resident causing the danger to another room or unit, pending investigation of the incident; closely monitor and document the behavior and condition of the residents involved to evaluate for any injury and to prevent recurrence of the incident; the facility must develop measures to prevent reoccurrence and document these measure in the resident's medical record to include revision of the plan of care." 61. On 10/25/11 at 8:35 AM with Resident #110 revealed she had an issue with her roommate Resident #97. The interview revealed that Resident #97 was no longer residing in the facility. Resident #110 stated that she had attended a cookie decorating activity the day before, 1S but when she returned to her room there were about 10 -12 cookies there. Resident #110 stated that she thought someone was just kidding with her, so she took the cookies to the staff to distribute. Resident #110 stated that when Resident #97 returned to the room and realized the cookies were gone she became very upset. Resident #110 stated that Resident #97 carried on for a while and the facility eventually transferred Resident #97 out of the facility via stretcher. Resident #110 revealed that she had been having issues with Resident #97 since the resident was admitted to the room about a week ago. Per Resident #110 revealed that Resident #97 was "very bossy, it disturbed her to be disturbed, it was terrible. I thought I can't handle this. She was in here only about a week. I didn't let the staff know. But when I had to use the bathroom, the staff was taking me down to where you get the showers, not to disturb the roommate." Resident #110 revealed that the staff was taking her to the shower room to also get her dressed. "I didn't like that. She had gotten dangerous. I was afraid. They took her out of here last night. I had my first good night sleep last night since she came." 62. A review of Resident #97s clinical record revealed that the resident was sent to the hospital for an involuntary examination (Baker Act) on 10/24/11. The Baker Act documentation revealed that Resident #97s mental illness diagnoses was a long history of Bipolar disorder, Depression, Anxiety Disorder, and Insomnia. The supporting doumentation revealed Resident #97 had made statements of wanting to die, uncooperative with staff attempts to work with her; made threats to all roommates in the past week with daily behavior escalating and was refusing medications. Other information relied upon to determine the need for Baker Act included, but was not limited to Resident #97 being agitated, refusing care, and threatening other residents; a. long term Bipolar disorder with worsening symptoms and risk to self and others escalating; and other residents are stating they are afraid of Resident #97. 63. A review of the doctor’s progress note dated 10/18/11 revealed that Resident #97 had ’ progressive depression and ‘was becoming increasingly agitated, and that there were many issues with all her perspective roommates. 64. A nurse's note dated 10/21/11 at 12:30 PM revealed that Resident #97 was very agitated and was verbally abusive to staff and roommate and had also threatened her roommate. 65. A weekly progress note dated 10/22/11 revealed that Resident #97 was agitated and verbally abusive to staff and to Resident #110 on 10/21/11. 66. A nurse’s note dated 10/21/11 at 5:30 PM revealed that Resident # 110 was afraid of Resident #97, and that she had cursed at her and had become very agitated. 67. Class “II” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines directly threaten ~ the physical or emotional health, safety, or security of the clients, other than class I violations. The agency shall impose an administrative fine as provided by law for a cited class II violation. A fine shall be levied notwithstanding the correction of the violation. §408.813(2)(b), Florida Statutes (2011) 68. Aclass II deficiency is a deficiency 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. A class II deficiency is subject to a civil penalty of $2,500 for an isolated deficiency, $5,000 for a patterned deficiency, and $7,500 for a widespread deficiency, The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class J or class II deficiencies during the last licensure inspection or any inspection or complaint investigation since the last licensure inspection. A fine shall be levied notwithstanding the correction of the deficiency. §400.23(8)(b), Florida Statutes (201 1) 69. The Agency cited Respondent for an isolated Class II deficiency. 70. The Agency gave a mandatory correction date of this deficiency of November 28, 2011. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,500 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §400.23(8)(b), Florida Statutes (2011). COUNT I 71: The Agency re-alleges and incorporates paragraph one (1) through five (5) of this Complaint as if fully set forth herein. 72. The Agency re-alleges and incorporates Count I through II of this Complaint as if fully set' forth herein. 73. Based upon Respondent’s cited State Class II deficiencies, it was not in substantial compliance at the time of the survey with criteria established under Part I of Florida Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Florida Statutes (2011). WHEREFORE, the Agency intends to assign a conditional licensure status to Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(7), Florida Statutes (2011) commencing October 28, 2011. CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court: (A) Make factual and legal findings in favor of the Agency on Counts I through IIT; " (B) Recommend administrative fines against Respondent in the amount of $5,000; (C) Impose a conditional license commencing October 28, 2011; ’. (D) Assess attorney’s fees and costs; and (E) Grant all other general and equitable relief allowed by law. 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 in the attached Election of Rights form. All requests for hearing shall be made to the attention of Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308, (850) 922-5873. | If you want to hire an attorney, you have the right to be represented by an attorney in this matter. 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 this 5 day of February, 2012 Agency for Health Care A 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 412-3640 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by US. Certified Mail, Return Receipt No. 7010 1670 0000 1044 4562 to: Facility Administrator Russell Ward, Consulate Health Care of Orange Park, 1215 Kingsley Avenue, Orange Park, ' Florida 32073 and by U.S.. Mail to Registered Agent Sharon Mason, 800 Concourse Parkway South, Suite 200, Maitland, Florida 3751 on February 2, 2012: D. Carlton Enfinger, Copy furnished to: Rob Dickson, FOM 20

Docket for Case No: 12-002469

Orders for Case No: 12-002469