VU STATE OF FLORIDA AES AGENCY FOR HEALTH CARE ADMINISTRATION 30.5 STATE OF FLORIDA, AGENCY FOR em HEALTH CARE ADMINISTRATION, 4 Petitioner, a) O- / Ss a / vs. AHCA NO: 10-00-013-NH INTEGRATED HEALTH SERVICES OF WEST BROWARD, Respondent. / ADMINISTRATIVE COMPLAINT ~ YOU ARE HEREBY NOTIFIED that after twenty-one (21) days from receipt of this Complaint, the State of Florida, Agency for Health Care Administration (“Agency”) intends to impose an administrative fine in the amount of $10,000.00 upon Integrated Health Services (IHS) of West Broward. As grounds for the imposition of this administrative fine, the Agency alleges as follows: 1. The Agency has jurisdiction over the Respondent pursuant to Chapter 400 Part Il, Florida Statutes. 2. Respondent, IHS of West Broward, is licensed by the Agency to operate a nursing home at 7751 W. Broward Boulevard, Plantation, Florida 33324 and is obligated to operate the nursing home in compliance with Chapter 400 Part II, Florida Statutes, and Rule 59A-4, Florida Administrative Code. 3. On May 13, 1999 a survey team from the Agency’s Area 10 office conducted a complaint investigation survey and the following Class I deficiency was cited. U U 3A. Pursuant to 42 CFR §483.13(c)(1)(), the facility must develop and implement written policies and procedures that prohibit mistreatment, neglect and abuse of residents and misappropriation of resident property. The facility must not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion. This requirement was not met as evidenced by the following observations: (1) During the review of resident #1’s clinical record on May 5, 1999 and May 13, 1999, it was determined fe the resident was admitted to the facility on April 14, 1999 with dia; Failure, Hypertension, S/P Below Mellitus, Osteoarthritis and Gastroeso} nosis to include End Stage Renal the Knee Amputation, Diabetes phageal Reflux Disease. a) The resident was documented in the nurses’ notes as being - alert with confusion. na resident was receiving dialysis treatments three times per we: b) On May 2, 1999 at 8:3 in the nurses’ notes as acting were cool to the touch and 0 p.m., the resident was documented unusual. The resident’s extremities vital signs were: temperature 94.2, pulse 78, respirations 20 and blood pressure was 79/41. The resident was started on oxygen at 2 liters per minute. | c) There was no documentation that the resident’s physician was notified about the resident’s change in status. The nurse documented that the resident would be monitored, but there was no documentation of the resident on the three to eleven shift. s subsequent vital signs documented d) The facility maintained documentation from the medication administration record (MAR) that the resident received Cardura 1 mg at 9:00 p.m., a antihypertensive medication utilized for the resident’s hypertension with medication had the potential t a side effect of hypotension. This ‘0 lower the resident’s blood pressure lower than previously documented. e) On May 3, 1999 at 7:00 a.m., the resident’s vital signs were documented as: temperature 97, pulse 78, respirations 22 and blood pressure 120/70. The resident’s extremities continued to be cool to the touch and the oxygen was in use. U oY f) Subsequent to thé 7:00 a.m. vital signs check on May 3,. 1999, the resident was sent for a dialysis treatment. The time the resident left the nursing home for dialysis treatment is unclear since the information was not documented in the resident’s clinical record or any other facility documentation requested. g) At 10:15 a.m. on May 3, 1999, the facility documented that the dialysis center called and reported that the resident was lethargic and couldn’t be dyed At 10:20 a.m., the facility documented that the resident’s physician was called about a blood pressure of 80/42. The facility did not maintain documentation to determine the time the resident's blood pressure reading was 80/42. h) During the review of the resident’s MAR on May 13, 1999, it was observed that on the morning of May 3, 1999 the resident was administered Norvasc 10 mg at 9:00 a.m., a antihypertensive and Vasotec 20 mg was documented as held because the medication wasn’t available. i) During the review of the resident’s clinical record from the dialysis center on May 13, 1999, it was noted that the center documented that the resident arrived at 10:40 am. and was lethargic and barely responsive. The resident’s blood pressure was 78/40 and heart rate was 89. The center documented that the nursing home was called about the change in the resident’s status and was told by a nursing home nurse that the resident’s blood pressure was 80/42 and the resident was administered Vasotec. j) The center documented that the resident’s physician was called and dialysis was held The resident’s blood pressure decreased to 49/29 and emergency services were called. The center was unable to start an intravenous infusion because the resident’s access site was clotted. : k) When emergency services arrived, the resident was intubated and cardiopulmonary resuscitation (CPR) was started. The resident was taken to pe hospital and at 11:20 am. the resident was pronounced dead. i) Based on the above information, it was determined that the facility failed to adequately assess the status of the resident, failed to notify the resident’s physician and when the resident had a change in condition, failed to communicate changes to the resident within the facility and failed to communicate changes in resident to the dialysis center. VY UY (m) The resident’s changes in condition occurred on the 3-11 shift and were not reported o 11-7 or the 7-3 shift. In addit the facility’s 24-hour report to the on, although the resident had access to at least eight licensed nurses and thirteen certified nursing assistants on the East wing, the resident’s changes in condition were not reported to the resident’s physician. (2) Based on clinical record re facility documentation, it was determ iew, interview and the review of ined that the facility violated Section 400.022(1)(L), F.S., for failing to ensure that one of six sampled residents was not neglected. 4. Based on the foregoing, Integrated Health Services of West Broward has violated the following: a. Tag F224 incorporates 42 CFR §483.13(c)(1)(i) and §400.022(1)(L), Florida Statutes. for the aforementioned violation. 5. The above referenced violations constitute grounds to levy this civil penalty pursuant to Section 400.23(8) and Section 400.102(1)(a)(d), Florida Statutes, and Rule 59A-4.1288, Florida Administrative Code, in that the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules, and regulations for the operation of a Nursing Home. NOTICE Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.57, Florida Statutes, to be represented by counsel (at its expense), to take testimony, to call or cross-examine witnesses, to have subpoenas and/or subpoenas duces tecum issued, and to present written evidence or argument if it requests a hearing. In order to obtain a formal proceeding under Section 120.57(1), Florida Statutes, Respondent’s request must state which issues of material fact are disputed. Failure to WU OG dispute material issues of fact in the request for a hearing, may be treated by the Agency as an election by Respondent for an informal proceeding under Section 120.57(2), Florida Statutes. All requests for hearing should be made to the Agency for Health Care Administration, Attention: R.S. Power, Agency Clerk, Senior Attorney, 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308-5403 All payment of fines should be made by check, cashier’s check, or money order and payable to the Agency for Health Care Administration. All checks, cashier’s checks, and money orders should identify the AHCA number and facility name that is referenced on page 1 of this complaint. All payment of fines should be sent to the Agency for Health Care Administration, Attention: Christine T. Messana, Staff Attorney, General Counsel’s Office, 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308-5403. 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. Issued this | say of February, 2000. Patricia Feeney Supervisor, Area 10 Agency for Health Care Administration Health Quality Assurance 1400 W. Commercial Boulevard, Suite 135 Ft. Lauderdale, Florida 33309 CERTIFICATE OF SERVICE I HEREBY CERTIFY that the original complaint was sent by U.S. Mail, Return Receipt Requested, to: Administrator, Integrated Health Services of West Broward, 7751 W. Broward Boulevard, Plantation, Florida 33324 on this2 (stday of February, 2000. Christi Office Copies furnished to: Christine T. Messana Staff Attorney Agency for Health Care Administration (interoffice mail) Pete J. Buigas, Deputy Director Managed Care and Health Quality Agency for Health Care Administration (interoffice mail) Area 10 Office Jim Mitchell, Finance & Accounting t . e T. Messana, Esquire of the General Counsel

Docket for Case No: 00-001541