J2-Y3 FILED STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION NOV ct 1 STATE OF FLORIDA, AGENCY FOR eran ech CLERK HEALTH CARE ADMINISTRATION, Petitioner, AHCA CASE NO.: 04-01.0058-NHt ve FIVE POINTS HEALTH CARE, LTD., d/b/a PARK RIDGE NURSING CENTER, Respondent. _ _ __/ ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against FIVE POINTS HEALTH CARE, LTD., PARK RIDGE NURSING CENTER, (“Park Ridge Nursing Center”), pursuant to Section 120.569, and 120.57, Florida Statutes, (2001), alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine against Park Ridge Nursing Home, pursuant to Section 400.23(8)(c), Fla. Stat. (2001), Rule 59A-4.109(1)(c); 59A-4.109(2), and 59A-4.106(4), Florida Administrative Code. (2001). JURISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to Chapter 400, Part I, Section 120.569 and 120.57, Florida Statutes, (2001), Chapter 59A-4 Florida Administrative Code (2001). 3. Venue lies in Duval County, Jacksonville, Florida, pursuant to Section 400.121(1)(e), and 120.57, Florida Statutes, (2001); and Chapter 59A-4, Florida Administrative Code (2001). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing skilled nursing facilities pursuant to Chapter 400, Part I, Florida Statutes, (2001), and Chapter 59A-4 Florida Administrative Code. 5. Five Points Health Care, LTD., d/b/a Park Ridge Nursing Center is a for- profit corporation, whose 104 bed nursing home is located at 730 College Street, Jacksonville, Florida. Park Ridge Nursing Home is licensed as a skilled nursing facility license ¥SNF1256096; certificate number 7330, effective July 16, 2001 through July 15, 2002. Park Ridge Nursing Center was at all times material hereto, a licensed facility under the licensing authority of AH'CA, and tequired to comply with all applicable rules, and statutes. COUNT I PARK RIDGE NURSING CENTER FAILED TO ENSURE THE IMPLEMENTATION OF THE STATE APPROVED RAI (Resident Assessment Instrument) THIS CITATION WAS FOUND NOT CORRECTED AT THE TIME OF THE REVIST OF 09/17/2001. FEDERAL TAG F272-COMPREHENSIVE ASSESSMENT 42 C.E.R. 483.20(b) STATE TAG NO072, 49A-4.109(1)(c), F.A.C. 6. AHCA tealleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On the revisit survey on September 17, 2001, Park Ridge Nursing Center was cited one (1) uncorrected class III deficiency pursuant to 42 C.F.R. 483.20(b), for failure to ensure that the State approved RAI (Resident Assessment Instrument) was completed, including RAP’s (Resident Assessment Protocol’s) needed to summarize all of the resident concerns in order to determine what care plans were needed to meet each residents needs. The assessment must include at least the following: @) Identification and demographic information. (ii) Customary routine. (iii) | Cognitive patterns. (iv) Communication. (v) Vision. (vi) Mood and behavior patterns. (vii) Psychosocial well-being. (viii) Physical functioning and structural problems. (ix) Continence. (x) Disease diagnoses and health conditions. (xi) Dental and nutritional status. (xii) Skin condition. (xiii) Activity pursuit. (xiv) Medications. (xv) Special treatments and procedures. (xvi) Discharge potential wi ttl ase (xvii) Documentation of summary information regarding the additional assessment performed-through the resident assessments protocols. (xviii) Documentation of participation in assessment. The assessment process must include direct observation and communication with the resident, as well as communication with licensed and nonlicensed direct care staff members on all shifts. This constitutes a violation of Settion 59A-4.109(1(c), Florida Administrative Code (2001), requiring that a complete, comprehensive, accurate and reproducible assessment of each resident’s functional capacity which is standardized in the facility, and is completed within 14 days of the twelve months, thereafter. The assessment shall be: 1. Reviewed no less than once every 3 months, 2. Reviewed promptly after a significant change in the resident’s physical or mental condition, 3. Revised as appropriate to assure the continued accuracy of the assessment. This is an uncorrected class III deficiency. Fine: $2,000.00. COUNT I~ PARK RIDGE NURSING CENTER FAILED TO DEVELOP CARE PLANS AS STATED IN THE PLAN OF CORRECTION THAT WERE MEASUREABLE. THIS CITATION WAS FOUND NOT CORRECTED AT THE TIME OF THE REVISIT OF 9/17/2001 FEDERAL TAG F279-RESIDENT ASSESSMENT 42 CER. 483.20(k) STATE TAG N0072-59A-4. 109 (2), F.C.A. ee ae a ee sey cere re tain iee dat ed.caotinea nated eee 8. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 9. On the revisit survey on September 17, 2001, Park Ridge Nursing Center was cited for one (1) uncorrected class III deficiency pursuant to section 42 C.F.R. 483.20(k), for failure to develop measurable care plans as stated in the plan of correction and included all care issues that were identified in the resident assessment. Without a plan of care for these residents, the facility cannot assist in enhancing the resident’s highest level of functioning by ensuring consistent care and services were provided. All of the above constitutes a violation of section 59A-4.109(2), Florida Administrative Code (2001), which requires that a facility is responsible to develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’s medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. The care must describe the services that are to be furnished to attain or maintain the resident’s highest practicable physical, mental and social well-being. The care plan must be completed within 7 days after completion of the resident assessment. This is an uncorrected class III deficiency. Fine: $2,000.00. COUNT IIL PARK RIDGE NURSING CENTER FAILED TO COMPLETE THE INVESTIGATION AND FOLLOW-UP ON ACCIDENTS OR IMPLEMENT APPROACHES THAT MAY PREVENT THE ACCIDENT FROM RECURRING. THIS CITATION WAS FOUND NOT CORRECTED AT THE TIME OF THE REVISIT 9/17/01 FEDERAL TAG F324—QUALITY OF CARE 42 C.F.R.483.25 (h)(2) STATE TAG NO0041, 59A-4,106(4), F.C.A. ogee rope de Masi 10. | AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 11. On the revisit survey on September 17, 2001, Park Ridge Nursing Center was cited for one (1) uncorrected class II deficiency pursuant to 42.C.F.R. 483.25(h)(2), providing that the facility must ensure that - (1) The Respondent environment remains as free of accident hazards as is possible; and (2) Each resident receives adequate supervision and assistance devices to prevent accidents. This is an uncorrected class III deficiency. Fine: $2,000.00. All of the above constitutes a violation of Section 400.23(8)(c), Fla. Stat. (2001), provides that class II] deficiency is a deficiency that the agency determines will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class III deficiency is subject to a civil penalty of $1,000 for in isolated deficiency, $2,000 for a patterned deficiency, and $3,000 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A citation for a class III deficiency must ap rose kM ai Peer teany ck behi A ikbs specify the time within which the deficiency is required to be corrected. If a class II deficiency is corrected within the time specified, no civil penalty shall be imposed. WHEREFORE, AHCA intends to impose an administrative fine against Park Ridge Nursing Center pursuant to Section 400.23(8)(c), Fla. Stat. (2001), Rule 59A-4.109(1)(c); 59A-4.109(2), 59A-4.106(4), Florida Administrative Code (2001), and 42 CFR. 483.20(b)&(k) and 42 C.F.R. 483.25(H)(2), (2001). Park Ridge is a skilled nursing facility in the State of Florida. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael O. Mathis, Senior Attorney. 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. TS RE TI TIES Re oe poe orem ee ee Ree See ae tae * + 4 Respectfully Submitted this ft od day of _[Ikvem ler 2001 Michael ©. Mathis Fla. Bar. No. 0325570 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, FL 32308 (850) 921-0055 (office) (850) 413-9313 (fax) Karen Swann Diane Grubbs Agency for Health Care Administration CERTIFICATE OF SERVICE certified mail on _ 1? day of Fis vem , 2001 to Greg Davis, Administrator, Park Ridge Nursing Center, 730 College Street, Jacksonville, Florida 32204. vere oper Sopp cette crepe rome Cre rp peerage

Docket for Case No: 02-000043