STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION OCT 340 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. MARINER HEALTH OF JACKSONVILLE d/b/a MARINER HEALTH OF JACKSONVILLE, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against MARINER HEALTH OF JACKSONVILLE, Respondent”), 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 Mariner Health of Jacksonville, pursuant to Section 400:23(8)(c), Fla. Stat. (2001), Rule 59A-4.1288, Florida Administrative Code, (2001) and 42 C.F.R. 483.25(c). JURISDICTION AND VENUE 2. This court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes, (2001). 3. Venue lies in Duval County, Jacksonville, Florida, pursuant to Section 120.57, Florida Statutes, (2001); and 59A-4, Florida Administrative Code (2001). onRr rier coger 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 II, Florida Statutes, (2001), and Chapter 59A-4, Florida Administrative Code. 5. Mariner Health of Jacksonville is a for-profit corporation, whose 163-bed nursing home is located at 4134 Dunn Avenue, Jacksonville, Florida. Mariner Health of Jacksonville is licensed as a skilled nursing facility license #SNF13500963; certificate number 6246, effective October 1, 2001 through September 30, 2002. Mariner Health of Jacksonville was at all times material hereto, a licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNTI MARINER HEALTH OF JACKSONVILLE FAILED TO PROVIDE CARE, TO ASSESS, AND DEVELOP CARE PLANS FOR RESIDENTS PRESSURE SORES. FEDERAL TAG F314-PRESSURE SORES 42 C.F.R. 483.25(c) STATE TAG-59A-4.1288, F.A.C. 6. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. | 7. On the original survey of July 30, 2001 and the revisit survey on September 4, 2001, Mariner Health of Jacksonville was cited for one (1) uncorrected class IIL deficiency pursuant to Section 59A-4.1288, F.A. C., and 42 C.F.R. 483.25(0), requiring the facility to ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the clinical condition demonstrates that they were cnn eee one Ts A ae alee ae unavailable and a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. This is a class Ill deficiency. Fine: $1,000.00 All of the above constitutes a violation of Section 59A4.1288, Florida Administrative Code (2001), which requires that nursing homes participating in Title XVIII or XIX must follow certification rules and regulations found in 42 C.F.R. 483, Requirements for Long Term Care Facilities, September 26, 1991, which is incorporated by reference. Non-certified facilities must follow the contents of this rule and the standards contained in the Conditions of Participation found in 42 C.F.R. 483, Requirements for Long Term Care Facilities, September 26, 1991, which is incorporated by reference with respect to social services, dental services, infection control, dietary and the therapies. The above also constitutes a violation of Section 400.23(8)(c), Fla. Stat. (2001), provides that a class III 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 is subject to a civil penalty of $1,000 for an 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 specify the time within which the deficiency is ik eee required to be corrected. If a class III deficiency is corrected within the time specified, no civil penalty shall be imposed. WHEREFORE, AHCA intends to impose an administrative fine against Mariner Health of Jacksonville for violation of Section 400.23(8)(c), Fla. Stat. (2001), and Rule 59A-4.1288, Florida Administrative Code, and 42 C.F.R. 483.25(c). Mariner Health of Jacksonville 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 NOTIFED 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. ee et eee i i A dt — ee Michael ©. Mathis Fla. Bar. No. 0325570 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0055 (office) (850) 413-9313 (fax) Karen Swann Diane Grubbs Agency for Health Care . Administration ; CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on 3/ + day of dtoh. , 2001 to John Simmons, Administrator, Mariner Health of Jacksonville, 4134 Dunn Avenue, Jacksonville, Florida 32218. Michael O. Mathis, Esq.

Docket for Case No: 02-000045