V2-3L/ PILED STATE OF BAgy il: 07 OCT 30 9} AGENCY FOR HEAL PA ADMINISTRATION VHog HEVISIE 8 DEPART MENS STATE OF FLORIDA, AGENCY FOR ADMI HEALTH CARE ADMINISTRATION, Petitioner, AHCA NO.: 04-01-0057-NH. vs. BEVERLY ENTERPRISES FLORIDA, INC. ' d/b/a BEVERLY HEALTH & RAHAB CENTER PARADISE PINES, Respondent. — _— _/ ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against BEVERLY ENTERPRISES FLORIDA, INC., d/b/a BEVERLY HEALTH & RAHAB CENTER PARADISE PINES, (“Paradise Pines”), 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 Paradise Pines, pursuant to Section 400.23(8)(b), Fla. Stat. (2001), Rule 59A-4.1288, and 59A-4.112, Florida Administrative Code (2001), and 42 C.F.R. 483.25(k)(c), and42 C.E.R. 483.60(a). JURISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). lA a Nl A ee 3. Venue lies in Duval County, Jacksonville, Florida, pursuant to Section 120.57, Florida Statutes (2001), and Chapter 59 Florida Administrative Code (2001). 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. Paradise Pines is a for-profit corporation, whose 180-bed nursing home is located at 11565 Harts Road, Jacksonville, Florida. Paradise Pines is licensed as a skilled nursing facility license #SNF15640961; certificate number 6848, effective March 1, 2001 through February 28, 2002. Paradise Pines was at all time material hereto, a licensed facility under the licensing authority of AHCA, and requested to comply with all applicable rules, and statutes. COUNT I PARADISE PINES FAILED TO ENSURE THAT RESPIRATORY CARE WAS PROVIDED AS PRESCRIBED FEDERAL TAG F426- PHARMACY SERVICES 42 C.E.R. 483.25(K)(6) STATE TAG NO170 59A-4.1288, F. A. C. 6. AHCA tealleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During a complaint investigation on September 4, 2001, Paradise Pines failed to ensure that tracheotomy care; suctioning, and respiratory treatments were provided as prescribed, for 1 out of 7 sampled residents, (Resident #5), having the potential for a direct impact on the respiratory function and status of the resident. The above OTE RE TARR PO TF constitutes a violation of 42 C.F.R. 483.25(k), (2001), requiring that the facility must ensure that residents receive proper treatment and care for the following special services: (1) Injections; (2) Parenteral and enteral fluids (3) Colostomy, ureterostomy, or ileostomy care; (4) Tracheostomy care; (5) Tracheal suctioning (6) Respiratory care (7) Foot care; and (8) Prostheses. This is a class II deficiency. Fine: $2,500.00. COUNT IL PADADISE PINES FAILED TO PROVIDE MEDICATIONS AS ORDERED FOLLOWING ADMISSION AND IN A TIMELY MANNER FEDERAL TAG F426-PHARMACY SERVICES STATE TAG N0090-PHARMACY SERVICES 59A-4.112, F.A.C. 8. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 9. On or about September 4, 2001, Paradise Pines failed to provide medications as ordered following admission and in a timely manner. The above constitutes a violation of Section 59A-4.112(1), F.A.C, requiring that facilities provide pharmaceutical services (including procedures that assure that accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident. This is a class II deficiency. Fine: $2,500.00. 10. The above also constitutes a violation of Section 400.23(8)(b), Fla. Stat. (2001), providing that a class II deficiencies are those which the agency determines have a direct or immediate relationship to the health, safety, or security of the nursing home ORT IE RE RRR Pree rene ree narage ce TR RN rer rene or facility residents, other than class I deficiencies. A class II deficiency is subject to a civil penalty in an amount not less $1,000 and not exceeding $10,000 for each and every deficiency. A citation for a class II deficiency shall 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, unless it is a repeated offense. WHEREFORE, AHCA intends to impose an administrative fine against Paradise Pines for violations of Section 59A-4.112, and 59A-4.1288, Florida Administrative Code, and 42. C.E.R. 483.25(k)(6). Paradise Pines is a skilled nursing facility in the State of Florida. Respondent is notified that they have a right to request an administrative hearing pursuant to 120.57, 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 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. Florida. OTE orner MER eRe mE eT EE ere meetin geen SOO Te RE ETE aera sae OR EE CEE NAW WIAA At Michael ©. Mathis Fla. Bar. No. 0325570 Counsel for Petitioner, Agency for HealthCare 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 | HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on 30th day of Ochs her , 2001 to: Connie Bend, Administrator, Beverly Health & Rehab. Center Paradise Pines, 11565 Harts Road, Jacksonville, Florida 32218. Copies furnished to: Connie Bend, Administrator Beverly Health & Rahab-Paradise Pines 11565 Harts Road Jacksonville, Florida 32218 Agency for Health Care Administration Finance & Accounting Department P.O. Box 13749 Tallahassee, Florida 32317-3749 Michael O. Mathis, Esq. Karen Swann Area Office #4 Supervisor Agency for Health Care Administration 921 North Davis Street. Suite 115 Jacksonville, Florida 32209 oe pee cere Se RR ea a

Docket for Case No: 02-000361