Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: THE MAGNOLIAS NURSING AND CONVALESCENT CENTER (PENSACOLA HEALTH CARE SERVICES, LLC, D/B/A THE MAGNOLIAS
Judges: DIANE CLEAVINGER
Agency: Agency for Health Care Administration
Locations: Pensacola, Florida
Filed: Aug. 21, 2000
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, October 25, 2000.
Latest Update: Dec. 23, 2024
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STATE OF FLORIDA Og “Wy b
AGENCY FOR HEALTH CARE ADMINISTRATION “ip, 7°. 4
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STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION,
Petitioner,
vs. AHCA NO; 02-00-062-NH
THE MAGNOLIAS NURSING AND
CONVALESCENT CENTER (Pensacola
Health Care Services, LLC d/b/a
The Magnolias,
Respondent, .
con /
ADMINISTRATIVE COMPLAINT
YOU ARE HEREBY NOTIFIED that after twenty-one (21) days from
reccipt 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 The Magnolias Nursing and Convalescent
Center (Pensacola Health Care Services, LLC d/b/a The Magnolias). As
grounds for the imposition of this administrative fine, the Agency alleges
as [ollows:
1. The Agency has jurisdiction over the Respondent pursuant
to Chapter 400 Part I, Florida Statutes.
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2. Respondent, The Magnolias Nursing and Convalescent
Center, is licensed by the Agency to operate a nursing home at 600 W.
Gregory Street, Pensacola, Florida 32501 and is obligated to operate the
nursing home in compliance with Chapter 400 Part II, Florida Statutes,
and Rule 594-4, Florida Administrative Code.
3. On July 14, 2000 a survey team from the Agency’s Arca 1
Office conducted a complaint investigation and the following Class |
deficiency was cited.
3A, Pursuant to 42 CFR 483.13(b), the resident has the right to
be free from verbal, sexual, physical, and mental abuse, corporal
punishment, and involuntary seclusion, ‘This requirement was not met
as evidenced by the following observations:
(1) Based on clinical record review, Resident #6 was
admitted to the facility May 19, 2000 with diagnoses which
included Reactive Psychosis, Chronic Mental IlIness and
Senile Dementia, She was admitted from another nursing
facility where she was known to have behavior problems that
included wandering, verbal abuse to other residents,
slapping residents and other violent behavior. Based on the
record, this resident had been denied a nursing home level of
care (meaning she was not appropriate for nursing home
care) due to her aggressive, inappropriate behaviors.
(a) The first Resident Assessment Instrument, dated
June 7, 2000, assessed the resident with mood and
behavior problems to include wandering into others
rooms, verbal and physical abuse, socially
inappropriate and resistive to care, Nursing notes and
social service notes indicated the resident began
exhibiting maladaptive behaviors upon admission.
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(b) Physician progress notes beginning May 23,
2000 note her agitation and aggressiveness with
subsequent notes from the psychiatrist that she is
angry, combative and hostile. By June 8, 2000 she js
more intrusive and her psychoactive medication was
increased. On June 9, 2000 the resident hit another
resident and was sent to the hospital for evaluation
and admission to a psychiatric unit.
{c) The facility placed the resident on an 8-day bed
hold. The resident was re-admitted to the facility on
June 14, 2000 and began exhibiting behaviors again,
particularly wandering in other resident's rooms.
There was no documentation that the resident was
stable upon return from the psychiatric unit and no
evidence the facility addressed her intrusive behaviors.
The care plan addressed some hehavior issues but did
not speak of interventions used for the intrusive
behavior that so often ended in altercations with
others.
(4) On July 1, 2000 the resident was observed by
staff hitting and choking another resident who was
wheelchair bound in that resident's room, On July 5,
2000 the resident is noted to have continued behaviors
of yelling at people and continually roaming into other
residents rooms--not easily’ redirected. Her
psychoactive medication was increased.
‘(c) On July 12, 2000 the resident was observed in
an altercation with another resident and later in the
day she was sent to the hospital for a change in
mental status. Interview with hospital staff on July 14,
2000 at 3:30 P.M., revealed the resident "finally settled
down and the psychiatrist was continuing to adjust
her medication",
(f) The facility again put the resident on an 8-day
bedhold. Other than increase psychoactive
medications, there was no evidence the facility
implemented effective measures to prevent further
incidents of aggressive behavior between this resident
and other facility residents.
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(g) Interview with three alert and oriented residents
on July 14, 2000 at 2:30 p.m, confirmed resident #6
had attacked two residents on the second floor of the
nursing home. One of these residents was involved in
the choking incident and still had a bruise on her
upper right arm from the attack.
(h) During an interview at 5:30 p.m. on July 14,
2000, one sampled resident revealed that he/she was
awakened on July 12, 2000 at approximately 6:45
am. by resident #6 attempting to enter another
resident's room. The resident interviewed called out to
resident #6 stating, "Do not go in there, it is not your
room and you need to go back to your own room."
Resident #6 entered this resident's room using profuse
profanity. Resident #6 then proceeded td’ attempt to
knock the TV to the floor,
(i) The resident who was interviewed also stated
that on July 4, 2000 at approximately 3:00 am.,
resident #6 had come into his/her room, removed a
full ice pitcher from the bedside table and struck the
resident's sleeping roommate in the forehead. ‘The
resident being interviewed called for staff assistance.
A staff member came to the room and was able to
rouse the roommate only after several attempts. ‘The
resident who was interviewed stated that no one from
administration had come to discuss the incident,
though he/she had told several staff members about
the situation,
(j) Record review for all three residents involved
revealed no documentation of the incident, The
resident interviewed is assessed (on the current care
plan) as being cognitively intact, with no
documentation of behavior concerns,
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(2) Resident #14 was admitted to the facility on March 31,
2000. Review of the clinical record, Social Service notes,
Nursing progress notes, History and Physical, and the
Incident report and a State reporting form for June 7, 2000,
revealed that resident #6 had entered the room of resident
#14 at 3:15 a.m., removed the sheet from the bed and placed
it on the sink. Resident #14 got out of bed and struck
resident #6 in the mouth causing the lip to swell, but with
no broken skin. Resident # 14 was sent to a local hospital
for evaluation to be admitted to the psychiatric facility
located on campus. Resident #14 was returned to the
facility with no change in interventions to address volatile
behaviors,
{a) Social Services notes of June 7, 2000, reveal
resident #14 has a history of wandering and
combativeness, with many negative behaviors
occurring in the previous facility. Review of the history
and physical reveal the resident has an above average
potential for violence, emotional lability, and is easily
agitated. Poor impulse control, history of aggression,
and potential! for further aggressive behavior, were also
noted as concerns.
(b) Resident Assessment Protocol (RAP) summary
dated April 14, 2000, triggers the following areas
related to mental status for care planning: Cognitive
loss, mood state, and behavioral symptoms.
Approaches include: refer to psychiatrist for consult
as needed, all staff to anticipate and meet needs daily
and provide reassurance, monitor for changes in
behavior and safety, explain all care, redirect and
reorient as needed.
(c) Nurses notes dated July 13, 2000, states
"wandered hall most of shift with no altercations with
other residents." Nurses notes indicate no evidence of
care plan alternatives in place to prevent aggressive
behavior. ‘
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(a) ‘Incident report and nursing note dated July 11,
2000 at 12 midnight, indicated that a CNA observed
resident #14 in the hall hitting another resident. The
other resident responded by hitting resident #14, and
causing 3 small skin tears on the right side of the face.
Review of documentation indicated both residents had
been wandering the hall throughout the shift. The only
intervention documented as result of the altercation
was both residents received Ativan. No evidence of
further approaches to prevent a recurrence of the
altercation was documented,
(3) Resident #12 was admitted to the facility from a
psychiatric hospital on March 31, 2000 with a history of
Mood Disorder secondary to multiple etiologies. Review of
the last progress note from the psychiatric hospital revealed
the resident to have a long psychiatric history with verbal
and physical aggression toward staff and residents, to
include biting and scratching. The resident was documented
as having low frustration tolerance and poor social
judgement. The overall conclusion documented on the
assessment was that the resident is an above average risk
for aggression.
(a) Prior to being admitted to the psychiatric facility,
the resident had resided in a local nursing home, but
was transferred out due to agitation, aggressiveness
and combativeness, The current resident assessment
revealed the resident to be cognitively classified as
having some difficulty in new situations only. Mood
indicators are documented as a sad face, and not
easily altered.
(b) Review of the clinical record revealed entries
from April 19, 2000 through June 5, 2000, referring to
"Increasing periods of agitation", "will scratch, kick
and bite if you get too close", "has become aggressive
and will pull other resident's hair or push them out of
the way". An order for Ativan 0.5 mg. every 8 hours
was obtained in April, with no specific occurrence
noted, then on July 3, following an altercation, the
dose was increased to a frequency of every four hours.
(c) According to the clinical record, the resident
historically has not responded to various antipsychotic
medications.
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(a4) On June 13, 2000 the resident grabbed a
nursing assistant’s arm, causing a 3 to 4" scratch.
(e) Nursing notes of July 1, 2000 indicate the
resident was involved in an altercation with another
resident at which time, while on the elevator with two
staff and the other resident, resident #12 bit the other
resident's buttocks, causing an abraded area, The
bitten resident responded by striking resident #12 in
the face. Incident report documentation reflects a final
disposition of the incident as "Resident instructed on
inappropriateness of behavior.". The clinical record
reflects mo further interventions to prevent a
recurrence.
Resident #1 was originally admitted on Juhe 22, 1999
with a medical history including depression, anxiety and
cellulitis of the leg (based on clinical record review), The
current care plan indicates the resident's primary concern as
"Impaired Coping Skills", evidenced by frequent health
related complaints and requests for medications. The current
assessment (5-24-00) indicates the resident is independent
cognitively with only 1 behavior concern, that of repetitive
health complaints.
(a) The nurses’ notes from May 12, 2000 through
June 24, 2000, reveal no "acting out" or aggressive
behaviors. On June 25, 2000, the resident became
irate, threw canned formula to the floor and verbally
"berated" the staff. On July 1, 2000, after being bitten
by another resident, resident #1 slapped the resident
and lunged at the resident, requiring physical
intervention by staff.
(b} On July 12, 2000, resident #1 was observed
hitting another resident in the face and head. The
other resident was sitting on the floor, hanging on to
resident #1's leg. Upon interview at the time, resident
#1 explained that upon hearing an argument he/she
attempted to intervene and was then attacked by the
other resident who attempted to choke him/her.
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(c) Nursing notes state that Resident #1 was
counseled by staff about the inappropriate behavior,
On July 15, 2000, resident #1 was seen slapping
another resident “over the use of the telephone". The
resident was taken out on a Voluntary Baker Act, and
returned to the facility 6 hours later. Based on
interview with staff, the resident's plan of care was
revised July 17, 2000 after 5:00 p.m. to include
monitoring on a ‘resident tracking form" every 30
minutes.
(a) The clinical record, including the current patient
care plan, contains no evidence of revisions and/or
interventions to address this resident's recent
aggressiveness,
(5) Based on resident and staff interviews during both the
complaint investigation of July 14, 2000 and the partial
extended survey of July 18, 2000, review of mcdical records,
incident reports, and reports to the State, it was determined
that the facility violated Chapter 400.022(o}, F.S., for failing
to prevent occurrences of residents being assaulted by other
residents, failing to report the altercations to the appropriate
authorities in a timely manner and failing to implement
systems to avoid reoccurrence of ongoing resident to resident
abuse, resulting in immediate jeopardy.
4, Bascd on the foregoing, The Magnolias Nursing and
Convalescent Center (Pensacola Health Care Services, LLC d/b/a The
Magnolias has violated the following:
a) Tag F223 incorporates 42 CFR 483.13(b) and Section
400.022(0), F.S. The administrative fine imposed for this
Class I violation is $10,000.00,
S. The above referenced violation constitutes grounds to levy
this civil penalty pursuant to Section 400,23(9}(c), Florida Statutes, in
that the above referenced conduct of Respondent constitutes a violation
of the minimum standards, rules, and regulations for the operation of a
Nursing Horne.
JUL-31-09 MON 09:59 AM THE MAGNOLTAS FAX NO, 8504321625
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-cxamine witnesses, to have subpoenas and/or subpoenas duces
teciun 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 dispute matcrial issues of fact in
the request for a heating, may be treated by the Agency as an election by
Respondent for an informal proceeding under Section 120.57(2), Florida
Stalutes. All requests for hearing should be made to the Agency for
Health Cace Administration, Attention: Sam Power, Agency Clerk, Senior
Attorney, 2727 Mahan Drive, Mail Stop #3, Tallahassce, Florida 32308.
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, cashicr’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, 2727 Mahan Drive,
Mail Stop #3, Tallahassee; Florida 32308-5403.
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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 YHE AGENCY, 5
~ “day QQ, 2000.
C Aral \
Donah Heiberg *
Field Office Manger, Area #1
Agency for Health Care
Administration
Health Quality Assurance
2639 N. Monroe Street, Suite 208
Tallahassee, Florida 32303
Issued this ¢
CERTIFICATE OF SERVICE
1 HEREBY CERTIFY that the original complaint was sent by U.S.
Mail, Retum Receipt Requested, to: Administrator, The Magnolias
Nursing and Convalescent Center {Pensacola Health Care Services, LLC
d/b/a The Magnolias, 600 W. Gregory Street, Pensacola, Florida 32501
on this 2 “lteday of » shy , 2000.
°
Christine T. Messana, Esquire
Office of the General Counsel
smo
Docket for Case No: 00-003494
Issue Date |
Proceedings |
Nov. 22, 2000 |
Final Order filed.
|
Oct. 25, 2000 |
Order Closing File issued. CASE CLOSED.
|
Oct. 24, 2000 |
Notice of Voluntary Dismissal (Respondent) filed.
|
Oct. 23, 2000 |
Order issued (Respondent`s Motion to Consoliddate and Continue are denied).
|
Oct. 20, 2000 |
Notice of Correction (filed by Petitioner via facsimile).
|
Oct. 19, 2000 |
Petitioner`s Response to Respondent`s Motion for Continuance (filed via facsimile).
|
Oct. 18, 2000 |
Motion to Consolidate 00-3494 and 00-4034 and Continue filed by Respondent.
|
Oct. 17, 2000 |
Amended Notice of Hearing issued. (hearing set for October 24 and 25, 2000; 10:00 a.m.; Pensacola, FL, amended as to hearing dates).
|
Oct. 12, 2000 |
Motion for Additional Day for Final Hearing (filed by Petitioner via facsimile).
|
Aug. 31, 2000 |
Notice of Hearing issued (hearing set for October 25, 2000; 10:00 a.m.; Pensacola, FL).
|
Aug. 31, 2000 |
Response to Initial Order (Respondent) filed.
|
Aug. 22, 2000 |
Initial Order issued. |
Aug. 21, 2000 |
Administrative Complaint filed.
|
Aug. 21, 2000 |
Petition for Formal Administrative Proceeding filed.
|
Aug. 21, 2000 |
Notice filed.
|