etd ee tdi Mar-19-2001.°02:33pm = From- T-104 P.002/018 Fel HORNE es, _ STATE OF FLORI pe AGENCY FOR HEALTH CARE "BloieAlo O\- Got 3: STATE OF FLORIDA, AGENCY FOR Aonfis "0h gecEAvED HEALTH CARE ADMINISTRATION, HE, Sra iy at tan UM ¥E WAR TS 2051 Petitioner, LEGAL DEPT. vs. AHCA NO: 02-01-0084-NH HERITAGE HEALTH CARE CENTER, Respondent. ee ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that after twenity-one (21) days from receipt of this Complaint, the State of Florida, Agency for Health Care Administration (‘Agency’) intends to impose an adininistrative fine in the amount of $3,500.00 upon Heritage Health Care Center. As grounds for the imposition of this administrative fine, the Agency alleges as follows: L The Agency has jurisdiction over the Respondent pursuant “to Chapter 400 Part II, Florida Statutes. 2. "Respondent, Heritage Health Care Center, is Hcensed by the Agency to operate a nursing home at 1815 Ginger Drive, Tallahassee, . Florida “39308 ‘and js obligated to operate the nursing home in compliance with Chapter 400 Part Il, Florida Statutes, and Rule 594-4, Florida Administrative Code. 3. On May 1-4, 2000, a survey ream from the Agency’s Area 2 Office conducted a recertification survey and the following Class III deficiency was cited. Ware18-2001; 02:33pm = From= T-104 P.003/015 3A. Pursuant to 42 CFR 483.75(1)(), the facility must maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete; accurately documented; - readily accessible; and systematically organized. ‘This requirement was not met as evidenced by the following observations: (1) ~~ Review of clinical records showed that the consultant psychiatrist recommended Depakote for resident #20 in November 1999 to address. her manic and psychotic behavior, but was never implemented by the facility, as confirmed by the staff. Progress notes written by the Pan ye VAN psychiatrist from December 1999 to April 2000 indicate, for however, that the resident has been taking Depakote, and ° recommend for present medications to continue. (2) Based on record review and staff interview, it was determined that the facility violated 5C\A-¢.1288, F.A.C., for failing to ensure accurate clinical information for | of 27 sampled residents. 4.. On June 13, 2000 a survey team from the Agency’s Area 2 Office conducted a follow-up survey and the following uncorrected Class D Ill deficiency was cited. aA. Pursuant to 42 CFR 483.75(1)(), the facility must maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete; accurately documented; readily accessible; and systematically organized. This requirement was not met as evidenced by the following observations: (1) Record review of resident #1 revealed that resident SK " #l’s treatment record contained a May 2000 and June 2000 £ fr treatment entries for which there were no physician’s orders. . ™ Additionally, these Q treatment entries specify different treatments for the same right heel wound condition. / Fella - Wigrt9-2001,° 02:33pm From Tied p.004/018- : “104 P. F119 (2) Record review of the physician’s orders for resident #1 reflect a third different treatment for resident #1’s right heel even _ though this third treatment was indicated as discontinued effective May 30, 2000 on resident #1’s May 2000 treatment record. (3) Record review of resident #5 ard #14 revealed that these residents were missing quarterly Minimum Data Sets (MDS). During surveyor interview, the Director of Nursing (DON) indicated that the MDSs for these residents had been coded incorrectly. (4) Chart review of residents #5 and #12 revealed quarterly MDS not on chart. DON waable to produce the missing MDS quarterly reports for these residents. (5) Inan interview with the DON on June 13, 2000 at 3:30 p.m., the DON stated that quarterly MDS is the same as 90 day billing MDS. DON told that MDS must be coded for quarterly as well as coded for billing. {6} Based on record review and interview, it was determined that the facility violated Rule 59A-4.1288, F.A.C., for again failing to ensure that maintenance of clinical records on each resident is in accordance with accepted professional standards and practices. 5. On July 18, 2000 a survey team from the Agency’s Area 2 Office conducted a second follow-up survely and the following - uncorrected Class Ul deficiency was cited. SA. Pursuant to 42 CFR 483.75(1)(l), the facility must maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete; accurately documented; readily accessible; and systematically organized. This requirement was not met as evidenced by the following observations: (4) . Upon chart review July 17, 2000, surveyor found that resident #5 was ordered nothing past oral per doctors order oh be and all medications and nutritional supplements were to be (\ a) Mare1a-2001. 02:34pm = From T-104 = P.O05/015 administered via gastrostomy ‘ibe due to the resident having recurrent pneumonitis from aspiration of food. Care plan indicated plans to enhance residents oral mealtime and intake with positioning and resident: food preferences. Interview with the Director of Nursing on July 18, 2000 at 9:30 am. revealed the dietitian should have omitted oral intake areas from the care plan interventions. Resident _ expired on July 18, 2000 at 11:05 a.m. and at 11:30 a.m., the Director of Nursing brought revised care plan in to put on resident’s chart and stated that she knew it was after the fact, but this was the care plan they planned to put on resident’s chart. (2) Based on record review and interview, if was determined that the facility violated Rule 5OA-4.1288, F.A.C., for again failing to ensure that maintenance of clinical records on each resident is in accordance with accepted professional standards and practices. a. On June 12-13, 2000, a survey tearm from the Agency’s Area 2 Office conducted a complaint investigation survey in conjunction with a follow-up survey and the following Class MW deficiency was cited. 6A. Pursuant to 42 CFR 483.20{k)(3)ti}, the facility must ensure that the services provided by the facility meet professional standards of quality. This requirement was not met as evidenced by the following observations: (1) | Surveyor record review of resident #1 on June 12-13, 9000 revealed that resident #1 did not receive wound care sees preventions and treatments as ordered. Record review EN revealed that resident #1 did not receive seven (7) scheduled \/ right heel treatments during May, 2000 and forty-three {43) « scheduled treatments to his suprapubic area from May, 2000 to June, 2000. Additionally, record review on June 12- 13, 2000 revealed that resident #1 was scheduled to receive monitoring of his lower extremities for pressure areas and multipadus splints every morning but did-not receive this pio service on twelve (12) occasions from May, 2000 through June 12, 2000. F118 ar=19-2001 02:34pm Fron T-104 P.008/ - 006/015 F119 (2) Surveyor #ecord review of resident #11 on June 12-13, ‘2000 revealed that resident #11 did not receive wound care preventions and treatments as ordered. Record review revealed that resident #11 did not receive forty-one (41) resident #11 was to wear bilateral heel protectors at all times, every shift, but did not receive this service on forty- two (42) occasions from April to May, 2000. (3) Surveyor record review of resident #15 on June 12-13, 5000 revealed that resident #15 did not receive wound care preventions and treatments 45 ordered. Record review revealed that resident #15 was to wear heel protectors while in bed but did not receive this service twenty-one (21) times on the 3-11 shift, twenty-six (26) times on the 11-7 shift and seven {7} times on the 7-3 shift during May, 2000. (4) Surveyor record review of resident #8 on June 12-13, 2000 revealed that resident #8 did not receive wound care preventions and treatments as ordered on May 12, 2000. Record review revealed that resident #3 was to receive coccyx decubitus treatment put did not receive the ordered treatment on June 4, 2000 and June it, 2000. (5) Surveyor record review of resident #16 on June 12-13, 2000 revealed that resident #1G was to receive cream application to his foot twice a day but did not receive this treatment ten (10) times between June 2-13, 2000. (6) Review of the ‘Glinical record for resident #2 revealed an order for Silvadene to coecyx wound every day. Review of ‘the treatment sheet revealed six (6) missed treatments during the month of May, 2000. The resident also has a order for Granulex spray to bilateral heels every shift and prn. Review of the treatment record for May revealed fifteen (15) missed applications. On May 10, 2000, the order was written to apply tiple antibiotic ointment to a skin tear on the left hand and cover with dressing OD; this treatment was not indicated as done on the treatment record on four (4) of the eighteen (18) days the order was in effect. Review of the clinical record for resident #4 revealed an order for Lotrisome cream and Mycostatin powder around suprapubic catheter stoma BID (twice daily). The treatment record for May, 2000 indicates thirty-seven (37) of the sisty- 1 ~ Mar-1-2001) 02:34pm From T-104 = P.007/016 two (62) scheduled treatments were not completed, and eight (8) of fourteen (14) scheduled treatments were not completed in June prior to the resident's transfer to the hospital. In addition, two {2} of five (5) applications of Bactroban ointment to left posterior knee were not completed in June, 2000 as ordered. (8) Review of resident 49's chart revealed resident under hospice care but facility assuming wound care for resident. MD order for wound care was "Granulex spray to bilateral heels every shift’. Review of treatment record for resident 49's wound care for April, May, and June of 2000 revealed the following missed or unsigned treatments: a. 703 shift nurse missed/ failed to sign wound care 5 of 25 days in April, 8 of 31 days in May, and 3 of 13 days in June. b. 3 to 11 shift nurse missed, failed to sign wound care 23 of 25 days in April. 21 of 31 days in May, and 12 of 13 days in June. ¢c. 11 to 7 shift nurse missed /failed to sign wound care 25 of 25 days in April, 26 of 31 days in May, and 10 of 13 days in June. (9) On June 14, 2000, at 1:30 p.m., interview with wound care nurse revealed that the facility nurses are providing wound care as ordered by MD for resiclent #9. (10) Review of the Physician Orclers for Resident #9 revealed facility had no signed orders from the date of residents re-admission on April 6, 2000 until survey date on June 13, 2000. ; : (11) Review of wound care treatment record for resident #13 revealed MD order to cleanse right hip wound with wound cleanser and apply hydrocoloid dressing every three (3} days and a second MD order to cleanse right hip wound with wound cleanser and apply hydrocoloid dressing as needed. Both orders were listed 2s current wound care orders. No MD order found to discontinue either order. Two nurses were signing wound care under both orders for treatment. Nurse one using the first treatment order ynissed/failed to sign for 6 of 10 scheduled wound care treatments in May of 2000 and Nurse two using the second treatment order performed wound care 4 times pr in May of 2000. F118 Mar-18-2001- 02:35pm = From Tri04 P oes/ois =F - . “119 (12) Based on record review and staff interview, it was determined that the facility violated 5GA-4.107(2), F.A.C., for failing to immediately record, date and sign verbal orders, inchiding telephone orders, by the person receiving the order. All verbal treatment orders shall be countersigned by the physician or other health care professional on the next visit to the facility. 7. On July 18, 2000, a survey team from the Agency’s Area 2 Office conducted a complaint investigation survey in conjunction with a follow-up survey and the following uncorrected class II! deficiency was cited. 7A. Parsuant to 42 CFR 483.20(k)(3){i}. the facility must ensure that the services provided by the facility meet pravessional standards of quality. This requirement was not met as evidenced by the following - observations: \ (1) Surveyor record review on July 1.7, 2000 of the nurse’s notes in resident #1’s medical record, revealed that on June (\ 12, 2000, resident #1 was noted to have a lesion to the right ‘oe temple with a scant amount of dried blood. Surveyor review of the physician’s orders in residen: #1’s medical record, revealed a physician’s order, dated June 12, 2000, that resident #1 should be referred to [lermatology Associates regarding right temple lesion and bleeding. (2) Surveyor record review on July 17, 2000, of the _oitarse’s notes in resident #1’s medicai record, revealed that on July 17, 2000, resident #1 was noted to have an enlarging lesion of the right temporal scalp. These same nurse’s notes also indicated that a ew order confirmation was completed because contact with Dermatology Associates “had confirmed that an appointmen:, previously scheduled for July 18, 2000 on behalf of resident #1, had been cancelled hy Dermatology Associates. Surveyor review of the physician’s orders in resident #1’s m edical record, revealed a physician’s order dated July 7, 2000 that resident #1 should receive the earliest appointment with Dermatology Associates because the resident had a “large bleeding lesion” on the 7 Re osiee Mar=1 Q-2001- 02:38pm Frome T-104 = P.010/018 right temporal scalp. Surveyor interview on July 18, 2000 at 9:45 am. with a unit nurse manager and surveyor record review of resident #1’s nurse’s notes confirmed that the facility had taken no action to obtain an appointment with Dermatology Associates on. behalf of resident #1 as ordered by the physician from Jume 12, 2000 to July 7, 2000. (3) On July 18, 2000 at 10:40 a.m. during observation of wound care on resident #3, surveyor abserved physical therapist perform wound care to Stage IV heel wound without following wound care orders prescribed by the MD. The physical therapist failed to cleanse the wound with wound cleanser and rinse with normal saline as ordered. During interview on July 18, 2000 at 11:00 a.m., physical therapist stated that she forgot to cleanse resident’s wound. (4) On duly 18, 2000 at 10:20 a.m. during observation of wound care on resident #3, surveyor observed wound care nurse perform wound care for resident, however, the nurse failed to measure the depth of the Stage If decubitus ulcer on resident’s coccy%. Resident’s wounc| was deep and depth measurement should be done to correctly stage the wound. (5) Surveyor record review, on July 18, 2000 of resident #1’s medical record, revealed a physician’s order dated June 15, 2000 that resident #1’s right lower leg was to be cleansed with normal saline, steri-strips applied, treated with triple antibiotic ointment and covered with Telfa every day until healed. Surveyor review on July 18, 2000 of resident’s - treatment records dated June, 2000 and July, 2000 revealed that this physician’s order had been inaccurately transcribed on both the June, 2000 and July, 2000 treatment records (omitting the application of triple antibiotic ointment and Telfa covering) and that nursing staff had documented that resident #1 had received the inaccurately transcribed treatment. (6) | Based on record review and staff interview, it was determined that the facility violated §59A-4.112(2), F.A.C., for again failing to ensure that physician’s orders were followed in a timely manner and as written fo: two (2) of the nine (9) sampled residents (#1, #3) resulting in a delayed diagnosis, treatments and incomplete treatments. F-119 Bl i | Mare 8-206" 02:35pm = From~ T-104 P.009/015 8. Based on the foregoing, Heritage Health Care has violated the following: a) Tag F514 incorporates 42 CFR 483.75(1)0) and Rule 4 ,P.AC. The administrative ine imposed for this uncorrected)violation is $2,500.00. b) Tag F281 incorporates 42 CFR 483.20(k(3)@) and Rules 59A-4.107(3): “4-TOOYF.A.C. The administrative fine imposed for this uncorrected violation is $1,000.00. 9. The above referenced violations constitute grounds to levy this civil penalty pursuant to Sectio 400.23(9){c), Florida Statutes, in that the above referenced conduct of Respondent canstitutes a violation of the minimum standards, rules, and regulations for the operation ofa Nursing Home. NOTICE Respondent is notified that it has a ‘ight ta request an administrative hearing pursuant to Section 120.57, Florida Statutes, To pe represented by counsel (at its expense], to take testimony, to call or cross-examine witnesses, to have subpoenas and/or subpoenas duces issued, and to present written evidence or argument if it requests piain a formal proceeding under Section 120.57(1), Florida Statutes, Respondent’s request must stare which issues of material fact are disputed. Failure to 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}, Flerida F-118 War-19-2001 02:380n From ] 7 Te104 P.OLI/01S. F118 Statutes. All requests for hearing should be made to the Agency for Health Care Administration, Attention: Sam Power, F gency Clerk, Senior Attorney, 2727 Mahan Drive, Mail Stop #3, Tallahassee, 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, 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, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308-5403. | RESPONDENT 18 ‘FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN a1 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 nis day of keoniend’ 2001. Donah Heiberg Field Office Manger, Area #2 Agency for Health Care Administration Health Quality Assurance 2639 N: Monroe Street, Suite 208 Tallahassee, Mlorida 32303 10 ol a a ae = Mell edie nian teste biclilhedln k. 6 Mar=19-2001 02:36pm = From- CERTIFICATE OF SERVICE at the original complaint was sent by U.S. ] HEREBY CERTIFY th Mail, Return Receipt Requested, to: Administrator, Fleritage Health Care Ast Gay Center, 1815 Ginger Drive, Tallahassee, Florida 32408 on this of _| clicads sf , 2001. Lhd Christine T. Messana, Esquire Office of the General Counsel Copies furnished to: - Christine T. Messana— Attorney 7 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 2 Office ~ Gloria Collins, Finance & Accounting il T-104 = P.O12/018 Fril8

Docket for Case No: 01-001604