Oct-23-2000 03:14pm — From-LEGAL 1-501-201-4801 T-317 ; P.002/010 F837 a> Vf STATE OF FLORIDA 0 f AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vA. ARICA NO: 10-00-074 NH BEVERLY ENTERPRISES FLORIDA, INC, D/b/g BEVERLY GULF COAST-FLORIDA, : INC, (fot WASHINGTON MANOR NURSING & REHABILITATION CENTER, Respandent. ) a 8 ca AIN YOU ARE HERERY NOTIFIED that after twenty one (21) days from the receipt af this complaint, the Agency for Health Care Adminisration (hereinafter referred to a5 the "Agency”) intends to impose an administrative fine in the amount af Two Thousand Eight Hundred ($2,800) Dollars upan Beverly Enterprises-Floride, Inc., d/b/a Beverly Gulf CoastFlorida Inc., d/o/a Waabingion Manor Nursing & Rehabilitation Center (hereinafter referred to as “Reapondent"). As graunds for this administrative fine, the Agency alleges as fallows: 1. The Agency has jurisdiction aver Respondent by virtue of the provisions of Chapter 400, Part I, Florida Statutes (F.S.) 2, Respondent is licensed wo operate at 4200 Washington Street, Hollywood, Florida 33021, 25 # nursing home in compliance with Chapter 400, Part I, (F-S.), and Chapter 594-4, Florida Administrative Cade FAL) 3. Fron ume $-8, 2000, as a result of @ survey conducted by personnel from the office af the Agency for Health Care Administration it was found: Oct-23-2000 03:14pm = From-LEGAL 1-501-201-4801 T3170 P.003/010 = F-BE7 (a) The resident bas the right to be free from any physical restraints imposed for purposes of discipline or canvenience, and not required to treat the residant’s medical symptoms. , " Based on abservetion, record review, and interview with facility staff, it was determined that the facility did not ensure that 1 of 33 residents was fee from physical restraints imposed for purposes of discipline ar convenience. The findings include the follawing: (1) During initial toar on 6/05/00 at 9:52 a.m., it was observed that Resident #28 had a mitt ta the left hand. An inquisy was made by the surveyor to ascertain the reason for the use of the mift, and the staff member on tour with surveyor reported that the mitt was to prevent the resident from the Gastrastamy the (G-tube). (2) During record review on 6/07/00 at 10:00 azn. the following etry was abssrved in a nurses note dated 6/02/00 at 9:00 am. “Residsar with mittens on both hands af spouse's request. Spouse wants miten on because she is fearful resident will go atk to hospital if G-mbe dislodge.” The following entry in the nurse’s notes, on 6/05/00 ar 8:00 am.: “Resident with minens on to prevent resident from pulling ow G tube. Resident's spouses requen minens, she is fearful resident will have to go back to hogpital if be pulls G the from stamach.” There was no documentation noted in the chart that the resident was assessed for the need of the minens, a physician's order ar a care plan prias to the application of mistens 10 the resident, A physician’s arder was also noted diving shis review. The order dared 6/05/00 at 10:15 p.m. documented the following: “Hand mittens to prevent pulling G-tuhe. Check visually Q 30 minutes, release Q 2 hours for exercise.” Ths findings were brought to the arenrion of the ADON. During imerview with the ADON at 10:20 aum., the nurses stated “The wife is very anxious and she wanted the mitt epplied for safety, so thar he won't pull our the G-rube. (3) Frher review of the clinical record did not result in documentation that the facility demonstrated the presence af a specific medical symptom 2 Oct-23-2000 03:14pm = From-LEGAL 1-801-201-4801 T3170 P.004/010 = F-B87 that would required the use of the mit and how the sé of the min would aasist the resident in reaching his or her highest level of physical and psychnsocial well-being. There was na documentation thar the inverdisciplinary team addressed the risk of decline at the time the mit was applied. The care plan noted in the seaident clinical record is dated 6/05/00. This is in violation of eaction 400.022(3)(a), (F-S.). Class III deficiency. This ia in violation of section 400.022(1)(), ¥.8. THIS 18 A BEPEAT DEFICIENCY FROM THE survey of §/05/99. $700 Fine. (b) The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his or her individually. Based on observation and interview, the facility did not pramaote care for residents in 2 manner and in an environment that maintains or enhances each resident's dignity. The findings include the following: (1) During an interview with an pusampled resident an 6/06/00 at 9:00 am., it wes revealed that this resident had placed his/her call light on at approximately 3 am. on 6/05/00 because he/she needed to urinate. According to this resident, no staff answered the call light for about 2 hours. After waiting approximately 2 hours, the resident had to begin to screams in order to get the attention af facility staff. The resident indicated that when the staff finally arrived to render assistance he/she had glready urinated on himvheraelf. Further investigation and a review of this resident's clinical secord revealed an MDS dated 3/18/00, which indicated thar, this resident has no cognitive impairments. (2) During the resident group imeriew sanducted on 6/06/00 st 9:00 am./ it was revealed that 6 of 21 residents could not get assisrance from staff unless that staff member has them on their assignment. Specifically, ane resident indicated thar he/she asks staff for assisvance when his/her leg falls of the wheelchair's leg rts. According ta this resident he/she will ask a staff passing by for assistance, and staff will 3 Oct-23-2000 03:14pm = From=LEGAL 1-801-201-4801 T3817 P.008/010 = F857 seply by saying, “You'rs not my resident”. Jn addition, another resident indicated that he/she experience the same problem when he/she needs their diaper changed. According to this resident the sraff tell the resident, You're not on my assignment”, and leave them to sit in a wet diaper. "This is in violation of section 400.022(1}(a), F.S. Class I deficiency. $700 Fine. THIS IS A REPEAT DEFICIENCY FROM THE SURVEY OF $/05/99. {c) The facility must store, prepare, distribute, and serve fond under sanitary conditions. assed on observation wes determined that the facility did not store, prepare, distribute, and serve {had under sanitary conditions. During the sanitation tour of the dietary department conducted on 6/05/00, the following sanitation violations were noted: (1) The entry doat of the walk-in-freezer did not close properly, which caused a heavy ice build up om the foods that were stared within the unit. Jt was determined thar the non-fitting deor could not properly cantro! the temperature of the unit within the temperature requirements. (2) Leftover turkey and cheese slices Were not properly labeled with 2 date. , (3) Paper napkins, plastic silverware, and adaptive eating wrensils were being stored within the mop roam/chemical storage closet. (4) The rear exit door of the kitchen did not close tightly; leaving 2 gap to the outdoors that canld allow the entrance of pests into the facility. (5) The rear wall of the kitchen was noted ta be coumbling and had Joose fitting tiles. . ,(Q Numerous ceiling venrs and ceiling tiles that were located throughout fond starage, dish room, and preparation areas were noted by rusted, molded, and with dust build up. Oet-28-2000 03:15pm = From-LEGAL 1-601-201-4801 T-317?-P.006/010 F-B57 (7) The temperature of the breaded fish patty located in the tray line steam tables did not mest the required minimal temperarure of 140 degrees F. The termperarure of the fish was recorded at 130 degrees F. -@) Cold foods were not kept refrigerated during the mes that the line wes in operation. ‘The lunch dessert (apple slices) and the thickened juices were eR aut at roors temperature While the line was in operation. (9) The walls, floors and doors of the main resident dining room were heavily soiled and in disrepair. . This is in violatian of section 400.141(9), F.8. Class tm deficiency. $700 fine. THIS IS A REPEAT DEFICIENCY FORM THE SURVEY OF 8/05/99. (a) __A facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to mact the needs of each resident. It was determined that the faciliry did not ensure thar residents receive accuratn, acquiring, and adminimrasion of medications ordered by the physicians to mect the needs of the residents. The findings include; (1) - During clinical record reconcilistian following a medication pbservation on 6/06/00 at 8:00 am., it was noted thet the medication administration record for Resident #32 documented that the resident had been receiving 5 mg Coumadin po. on a daily besis since 4/10/00. During clinical recard reconriliation, it was determined tha the resident had a physician's onder dated 4/10/00 for Coumadin 2.5'mg gd po. Review of the Medication Administratin Records (MAR) far this resident revealed that the ardey for Coumadin 2.5. mg had been transcribed as Coumadin 5 mg. On 5/24/00, an order was noted to “Hald Coumadin for 4 days” as a reguit of an abnormally high Prothrombin Time, (8 laboratory test used ta determing the effectiveness Oct-23-2000 03:15pm — From-LEGAL 1-501-201-4801 Teal? -P.O07/010 = F887 4 of blood thinners such as Coumadin). On 5/31/00, 2 physician's order was noted to ssesuart Coumadin AO” JAO being used as an abbreviation for “as ordered”) The medication wes restarted as Coumadin 5 mg p.o. qd. Review of the rasults of laboratory teats from 4/10/00 to 6/05/00 revealed frequent indications of Prothrombin Time levels above normal limits, sometimes indicated as “critical” levels. Turing thet time, a Demtal Comme” was indicared with a diagnosis of bleeding gums and “coagulepathy”, both possible indications for an abnormally high Prothrombin Time. Interview with the ADON and the DON revealed that ‘the facility had transcribed and administered the wrong dose of Coumadin for this resident since 4/10/00. Interview with the Advanced RN Practitioner (ARNP) caring Sor this resident revealed that he/she was aware of the Prothrombin Time levels and the administration of 5 mg of Coumadin on @ daily basis since 4/10/00, However, he/she did not feel that the double douse had heen harmful to the resident. Following surveyor intervention, the ARNP wrote an order for “Coumadin 5 mg p.o. qd.” However, the resident had received the wrong dose af the medication far 69 days prior to the record review. (2) 0m 6/05/00, dusing the review of Resident #9 clinical recand, i was observed that a Social Service note dated 3/20/00 specified “Pt. Was seen by a paychianist on the 15" day of March. She was diagnosed of depressive mood end put her an antidepressant Paxil S mg daily.” A psychiatrist consult contained in the record dated 3/15/00 was noted 10 specify, “Impression-Major Depression." The Tecammendation noted was Paxi) 5 mg Q am. An order for Paxil was tranacribed 3/18/00 for Paxil 5 mg QD. Furher review of the recard revealed that the record did not contain any docurnentation ta substantiate the sdministration af the madication as ordered. The MAR for 3/20/00 revealed that the medication was not administered for 15 days. The MAR contained documentation on 3/16, 3/17, 3/20, 3/22. 3/25 snd 3/27, that the reason why Paxil 5 mg 3 tab was aot given “nor available, pharmacy called.” Qn 3/29 the reason LJ Oct-23-2000 03:15pm — From-LEGAL 1-801-201-4801 T7317 -P.008/010 = F857 specified for why the Paxil 5 mg was not adroinistered was “Social Services working on financial stevis.” ‘The Social Services’ note dated 3/20/00 specified that “The social worker had a long meeting with the resident to discuss with the usefulness of the medication. She agreed ther she wil] take the medication and alsa pay for it.” Interview with the consultant phannacist and clinical manager on 6/06/00 at 3:09 p.m. reported that she has to pull records to see Why medications were not dispensed for resident #9 4s to the computer states resident is “Label Only” which is why it may not have been dispensed “Label Only” is the category when medications are not seat 10 facility Som pharmacy. The Resident may heve never had medications sent i Sarility from pharmacy much as on. the occasions when they are private pay, private insurance or HMO reimbursement. “If it is the first time request for medications for @ patient, the pharmacy usually verifies payer source." The DON specified in an interview on 6/07/00 at 2:27 p.m. that “the day shift nurses were the only ones aware of this and all they would have to d 9 wes to call the pharmacy and me or the ADON would have given approval and they would have sent it. The day nurses tied to take care of it on their own and just war's with Social Services.” The yesident did not receive the ordered medication becanse of canfusion regarding the payer status of the resident. , (3) During the review ofthe MAR as it relates to the abave example, it was observed that Megace was not administered to Resident #9 for 12 days. Review of the physician order sheet specifies an arder on 3/17/00 for Megace oral susp 40 mg/ml 20 ec po QD. Decumenration on the MAR dared 3/18/00 specifies that the reason the Megace was not edministered was “not availabls, pharmacy called.” On 3/27/00, the MARA specifies “Megace 40 cc” as not given — social services working on financial status.” The resident did not receive the medication as ordered because confusion regartling the payer syarus of the resident. _ Oct-28-2000 03:16pm From-LEGAL 1-801-201-4801 T-317-P.008/010 © F857 This is in violation of rule 594-4.1 12(1), F-AC. Class I deficiency. $700 Fine. THIS IS REPEAT DEFICIENCY FROM THE SURVEY OF 5/05/99. 4, The ahove ¢ referenced violations canstimte grounds to levy this edministrative fine pursuant, to Section 400.121, (FS.), in that Respondent has violated the minimum standards, rulgs and regulations promulgared by the Agency under Chapter 400, Part I, €-.8.). , All requests for hearings shal! be made to: Agency for Health Care Administration Manchester Building, Ist Flaar £355 N.W. SSrel Soret Miami, Florida 33166 ‘Anention: Alba M. Rodriguez, Assistant Geneval Counsel Payment of fines shall be made to: Agency for Health Care ‘Administration ® P.O. Box 13749 Tallahassee, Florida 323 17-3749 5. Respondent is notified thar it has a right to request an administrative , hearing pursuant to Section 120.569, (F.8.}; to be represented by counsel (at its expense); to take teatimeny, to -call and cross-examine witnesses, 1a have subpeenas and/or subpocnas duces tecum issued, and to present writen evidence or argument if jt requests ¢ hearing. In order to obtain a formal proceeding, your request for an adminiswarive hearing must conform to the requirements in Rule 28-106.201, (F-A-C.), and must state which issues of material fact you dispute. Failure to dispute material issues-af fact in your request for @ hearing may he treated by the Agency és an election hy you of an. informa] proceeding under Section 120.57(2), F.5.) é. RESPONDENT 18 FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY ONE (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. Fy Oct-28-2000 03:18pm — From-LEGAL + 4 1-801-201-4801 T3177) P.O10/010 «= F-887 L HEREBY CERTIFY that a tus copy hereof was sent by U.S. Certified Mail, Return Receipt Requested to Adminimratar. Washington Manor Nursing and Rehabilitation Center, 4200 Washington Srrect, Hollywood, Florida 33021, Corporation Service Company, Registered Agent, 1201 Hays Sreet, Tallahassee, Florida 32301-2525, and to Beverly Pricrprises-Florida Ine., 1000 Beverly Way, Forth Smith, AR 72919%0n this / Pray of Ocbabers 2000. : \ ats 8 igor er rau 1400 We West =: Commer By Suste 100 Fr, Lauderdale, Florida 33 Mam Florida 33166 “Copy to: Alba M. Rogriguer, : Aasistant General Counsel for Fist Health C are Manchester pring Yat Flaor 8355 N.W. Sand Sr : Miami, Florida 33 ie Nuraing Home Pra Oise Agency f pa Health th Care 2727 397 Mahan “an Drive Tallahassee, Florida 32308 Finance and Accounting Agency for Health Care Administration _ 2727 Mahan Drive Tallahassee, Flarida 32399 NOTE: In accordance with the Amerisand with Disabilities Act, persans needin 8 Bpecial accommodation to parti in this procesding shavld contact Alba M. Radriguez no laves than fauroen (1°) prior te the proceeding or hearing & wt which such ape ecias aceommoda’ Alba M. Radri Bay be ar 8355 NW S3rd Street, Miami, ni, Florida jaa 33166. Telephone: (305) 499-2165 or eae Ss 8770 (voice) vie Florida Relay Service. 8

Docket for Case No: 00-004734