B ‘Certified Article Number : f 706 4575 1294 2049 £503 SENDERS R STATE OF FLORIDA ERS RECORD AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR OT- Sl of HEALTH CARE ADMINISTRATION, Petitioner, vs. THE HEALTH CENTER OF PENSACOLA, INC., d/b/a HEALTH CENTER OF PENSACOLA, 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 $2,000.00 upon The Health Center of Pensacola, Inc. ((‘Respondent” or “Health Center of Pensacola”). 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 II, Florida Statutes. 2. Respondent, Health Center of Pensacola, is licensed by the Agency to operate a nursing home at 8475 University Parkway, Pensacola, Florida 32514 and is obligated to operate the nursing home in compliance with Chapter 400 Part II, Florida Statutes, and Rule 59A-4, Florida es Soran aera sarees Bl oN f 3. On February 15-17, 2000 a survey team from the Agency’s Area 1 Office conducted a survey and the following Class III deficiency was cited. 3A. Pursuant to 42 CFR 483.25(i)(1), based on a _ resident’s comprehensive assessment, the facility must ensure that a resident maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident’s clinical condition demonstrates that this is not possible. This requirement was not met as evidenced by the following observations: (1) Review of the clinical record of resident #1 revealed a nutritional assessment completed on November 12, 1999, which assessed the resident to need an estimated 1,445 to 1,767 calories per day. Further review of physician and nurses progress notes revealed that on June 14, 1999, the resident's tube feeding was decreased to Osmolite HN Plus at 35cc per hour due to an episode of vomiting the day before and "excess mucous noted drooling down chin." This administration rate provided the resident with 1,008 calories per day, which was half of the amount of formula being previously administered. The resident remained on the 1,008 calories per day until he was weighed in July and was noted to have lost 6.5 pounds. (2) On July 13, 1999, the resident's physician increased the . tube feeding back to the previous 70cc per hour due to the weight loss. Nursing notes from June 14, 1999 to July 13, 1999 indicated that the resident was tolerating the tube feeding without any further difficulty. At the time of the survey, the resident had a recorded weight of 141.2 pounds on February 7, 2000. This was a -9-pound weight gain since the tube feeding was increased on July 13, 1999. (3) Resident #6 was assessed as a weight concern with a need to maintain body weight. There were several approaches in her care plan designed to maintain her rere é 4 weight but none included a supplement with the medication pass. In October of 1999, the resident ' weighed 110.8 pounds. Her December 1999 weight was 103 pounds. By February 7, 2000, the resident's weight had dropped to 97.4 pounds, a 13 pound weight loss in five months. On December 21, 1999, the Registered Dietitian recommended 2 cal HN 60cc with med pass. Interview with staff on February 15, 2000 at 1:15 p.m. revealed that nursing had not followed through with the recommendations to prevent further weight loss and the resident was continuing to lose weight. (4) Based on interviews with facility staff, observation, and review of 2 of 26 sampled residents, it was determined that the facility violated 42 CFR 483.25(i)(1), Federal Regulations, §400.141(7), Florida Statutes, and Rule 59A-4.1288, F.A.C., for failing to maintain acceptable parameters of nutritional status. 4, On March 25-29, 2001 a survey team from the Agency’s Area 1 Office conducted a survey and the following repeat Class Ill (by date of survey, this tag had been reclassified as Class II) deficiency was cited. 4A. Pursuant to 42 CFR 483.25(i)(1), based on a resident’s comprehensive assessment, the facility must ensure that a resident maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident’s clinical condition demonstrates that this is not possible. This requirement was not met as evidenced by the following observations: (1) Resident # 11 was admitted to the facility on November 17, 2000 with diagnoses to include in part Burns to 10-19% of body, Parkinson’ Disease, Paralysis agitans, Undersocialized Conduct Disorder with aggressiveness and agitation, Anemia, Upper GI Bleed. a. The resident was also noted to have a Stage II decubitus on the left buttocks on admission. His/her admission weight was recorded at 121.4 lbs. and height was recorded at 64 inches and a usual body weight of 130 pounds. . The resident’s nutritional needs were calculated on an inaccurate height and body weight recorded at the time of admission. The resident was placed on a Pureed diet with Ensure supplements three times a day (with meals) and snacks between meals. Further review of the chart indicated the resident gained up to 125.6 pounds by January 1, 2001. However, on January 24, 2001, the Ensure supplements were discontinued following recommendations by the facility dietitian. Documentation on December 6, 2000 indicated the - wound to the resident's coccyx had healed. Nutrition progress notes on February 11, 2001 stated: “notified by DON (Director of Nursing) of open area to left buttocks" and on March 17, 2001 was noted to have three open areas to the left buttocks and coccyx. _ By March 5, 2001, the resident's weight had dropped to 120 pounds. On March 4, 2001, physician orders were noted to re-start Ensure supplements four times a day along with additional protein supplements. On March 6, 2001, an appetite stimulant was added. , On March 15, 2001, the order was changed to 2 cans of ensure with each meal. During the first 2-3 weeks in March, his/her oral intake was recorded at 50% or less (including the 2 cans of Ensure) for 13 of 18 days. On March 5, 2001, the resident was placed on IV hydration. A family member, who had been designated as the resident's Health Care Proxy, was contacted per physician orders on March 6, 2001 regarding PEG tube placement and an interdisciplinary note on March -9, 2001 by the social worker that stated: "Resident very confused, refusing meals. Has been doing better last couple of days. Family approved _ tube feeding if needed." The resident was admitted to an acute care setting on March 18, 2001 with diagnoses to include GI bleeding, Anemia, and Urinary Tract Infection. 4 ond p. Upon return to the facility on March 23, 2001, the resident was documented to have multiple open areas, including an unstagable open area with yellow granulation on the left lower buttocks, and continued decreased appetite. q. Intake documentation since return to facility had been poor to fair with an increase in appetite up to 85-100% noted only during the last 2 days of the survey (March 28 & 29, 2001). r. On 3/25/01 the resident was sent back out to the hospital because of dehydration, cloudy urine, poor po (oral) intake, elevated temperature, and being unable to sit up. He/she returned to the facility the following day, on March 26, 2001, with a diagnosis of Pneumonia. Review of lab results revealed a serum albumin documented on November 16, 2000 (on admission) was 3.2 g/dl. Subsequent Albumin levels showed a continuous decline, indicating the resident's inability to maintain adequate protein stores and nutritional status, with the following results: (1) December 28, 2000 - 2.9 g/ dl; (2) January 25, 2001 - 2.7 g/dl; (3) February 12, 2001 - 2.5 g/dl; (4) March 4, 2001 - 2.4 g/dl; and (5) March 25, 2001 — 1.7 g/dl. s. The most current Albumin level on March 27, 2001 is documented at 1.8 g/dl. t. At the time of the survey and initial review of the resident's record on March 27, 2001, interventions for aggressive nutritional support had not been considered or offered to the. resident even though permission for such was given by his/her family on March 9, 2001. (2) Based on interviews with facility staff, observation, and clinical record review of 1 of 27 sampled residents (# 11), it was determined that the facility violated 42 CFR 483.25(i)(1), Federal Regulations, §400.141(7), Florida Statutes, and Rule 50A-4.1288, F.A.C., for again failing to maintain acceptable parameters of nutritional status.. c i 5. Based -on the foregoing, Health Center of Pensacola ‘has violated the following: a) Tag F325 incorporates 42 CFR 483.25(i)(1) and Rule 59A-4.1288, F.A.C. The administrative fine imposed for this repeat violation is $2,000.00. 6. The above referenced violations constitute 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 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 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: Sam Power, Agency 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, Finance & Accounting, Attention: Gloria Collins, 2727 Mahan Drive, Bldg. #2, Mail Stop #14, Tallahassee, Florida 32308. . 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. p> Issued this | day of C iQ. , 2001. /, Sah Heiberg Field Office Manager, Areas 1 & 2 Agency for Health Care Administration Health Quality Assurance 2727 Mahan Drive, Bldg. 2, MS#46 Tallahassee, Florida 32308 i CERTIFICATE OF SERVICE I HEREBY CERTIFY that the original complaint was sent by U:S. Mail, Return Receipt Requested, to: Administrator, Health Center of Pensacola, 8475 University Parkway, Pensacola, Florida 32514 on this sSheday of sil 2001. Christine T. Messana, Esquire Office of the General Counsel Copies furnished to: Christine T. Messana Senior Attorney Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, MS#3 Tallahassee, Florida 32308 a Elizabeth Dudek, Deputy Secretary Managed Care and Health Quality Agency for Health Care Administration 2727 Mahan Drive, Bldg. 1, MS#12 Tallahassee, Florida 32308-5403 Donah Heiberg Area 1 & 2 Field Office Managed Care & Health Quality : Agency for Health Care Administration 2727 Mahan Drive, Building 2, MS# 46 Tallahassee, Florida 32308 Long Term Care Unit MS#33 Gloria Collins Finance & Accounting MS# 14

Docket for Case No: 01-003139