STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINIST: (o} 5 PSO 29° AK LT: 05 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, ; ; AHCA NO. 10-01-0073 NH NME PROPERTIES CORP : Return Receipt Requested d/b/a LAGO VISTA CARE CENTER 7000 1670 0011 4847 3175 7000 1670 0011 4847 3205 Respondent. 7000 1670 0011 4847 3199 ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel ;” files this Administrative Complaint against NME Properties Corp d/b/a/ Lago Vista Care Center (hereinafter “Lago Vista”) pursuant to 28-106.201 Florida Administrative Code (2000) (F.A.C.) and Chapter 120, Florida Statutes ("F.S.") hereinafter alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of ten thousand five hundred ($10,500) dollars pursuant to Section 400.121 F.Ss. a cee ROTA PR re oe pe IR ee ers ome REE Bee eee ie eee AR ae a aed ae JURISDICTION AND VENUE 2. The Division has jurisdiction pursuant to Section 120.569 and 120.57 F.S. and Chapter 28-106 F.A.c. 3. Venue lies in Palm Beach County, Florida. PARTIES 4. AHCA, a subdivision of the State of Florida is the Agency charged with the enforcing authority with regard to skilled nursing facility licensure law pursuant to Chapter 400, Part II, F.S. and Rules 59A-4 F.A.c. 5. Lago Vista is a skilled nursing facility located at 5430 Linton Boulevard, Delray Beach, Florida 33484, and is licensed under Chapter 400, Part II, F.S. and Chapter 59A-4. F.A.C. COUNT I LAGO VISTA FAILED TO PROMOTE CARE FOR RESIDENTS IN A MANNER AND IN AN ENVIRONMENT THAT MAINTAINS OR ENHANCES EACH RESIDENT’ S DIGNITY. 59A-4.1288 F.A.C. AND 400.022(1)(n) F.S. CLASS II 6. AHCA realleges and incorporates (1) through (5) as if fully set forth herein. 7. This deficiency remained out of compliance during the revisit of 8/23/01.Based upon observation and interview on the Mauve Unit and the area near the main dining room, the facility did not promote care for residents that maintains or enhances cere come eee ee re oe errr i ee ee i a ee a ee dignity and respect for two (2) of twelve (12) sampled residents and one (1) Random #13 of one (1) random resident. 8. During tour at approximately 9:30a.m. a resident approached the surveyor and stated that she had been asking for a "diaper" every night for the last several nights and that the staff would not provide her with the diaper for the time period when she slept, even though it is noted in her care plan. The resident went on to say that it is very uncomfortable for her to lie in her urine and that it makes her "feel terrible about myself". She added the staff only came in when they make their rounds during the night to change the pad on which she is lying. As a result the resident does not have her dignity maintained. 9. During tour, another resident the roommate to the previous resident, also reported that her request for "diapers" for when she is to be sleeping is also ignored. This resident has incontinence of urine and repeated that the pads on the bed where she lies are changed only during nightly rounds. 10. During survey surveyor also observed Resident # 13 in the hall just outside the dining room with a belt restraint that had black, brown, and red stains covering the cloth belt, so many stains that it was difficult to tell the original color of the belt restraint. Surveyor alerted a staff person, the activity assistant, who said that she would take the resident to get a clean belt. Seem reine SR me Se a ee RE FREE RE I RR Te = 11. Based on the foregoing, Lago Vista violated 59A-4.1288 F.A.C. and 400.022(1)(n) F.S. herein, classified as a class ITI violation, and carrying in this case, an assessed fine of $3,500. COUNT II LAGO VISTA DID NOT ENSURE A CLEAN AND HOMELIKE ENVIRONMENT FOR THE RESIDENTS. 59A-4.122(2) (a) F.A.C. CLASS III 12. AHCA realleges and incorporates (1) through (5) as if fully set forth herein. . 13. Survey investigation showed that the facility at least in the Mauve Unit, did not provide housekeeping and maintenance services to maintain a sanitary, orderly and comfortable interior. 14. During tour surveyor noted that rooms 102,106,109,111, and 116, had cubicle curtains that were dirty and/or stained with brown, black, tan and/or red matter. The District Manager for Housekeeping was made aware of the curtains, who admitted that the cubicle curtain in Room 109 was "a mess." 15. Surveyor also noted the IV pole base in Room 109 had a heavy accumulation of black and gray matter. ee A ee fe creme greeter fe egg ee a a ne oe STE ome ap tree REET Ree pepe ay pe eee 16. Also during tour of the facility, surveyor noted a brown substance in three different places on the Eloor by the door bed in room 102. 17. During tour at approximately 9:15am, an offensive odor was permeating from the bathroom into the Bedroom of Room 101. 18. During tour at approximately 9:30am, splinters were observed on the door to the bathroom of Room 114. The nurse touring immediately went to get tape to cover the splinters so no one would get hurt. 19. At approximately 2:30pm, the resident in room 111 was interviewed. He/She is a 91-year-old oriented resident and was asked how he/she felt about the cubicle curtain. He/She said, "Honey, I’ve asked them to clean it many times and you see, it’s still dirty." 20. Based on the foregoing, Lago Vista violated 59A- 4.122(2) (a) F.A.C., herein classified as a class IIt violation, and carrying, in this case, an assessed fine of $1,500. PRAYER FOR RELIEF 21. WHEREFORE, the Plaintiff, State of Florida, Agency for Health Care Administration requests the Court to order the following relief: rr et ee ee ee } A. Enter a judgment in favor of the Agency for Health Care Administration against Lago Vista on Counts I and IT. B. Assess against Lago Vista an administrative fine in the amount of $10,500 for the Class II and Class III violations in Counts I and II in accordance with Section 400.121 F.S. 7 Cc. Asess costs related to the investigation and prosecution of this case pursuant to 400.121(10), Fla. Stat. (2001). D. Grant such other relief as the court deems is just and proper. 22. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Issued this _@/ _ day of “Doualoee/ 2901. Agégistan eral Counsel Agency for Health Care Administration 8355 NW 53*° Street Miami, Florida 33166 penne pe nee oe Seauaekataiceiaeeeeel oe REET RT eee ee ee ee TERE re oR Re Certificate of Service .I HEREBY CERTIFY that a true and correct copy of the foregoing complaint and election of rights was sent by U.S. Certified Mail, Return Receipt Requested to Administrator, Peggy A. Booth, Lago Vista Care Center, 5430 Linton Boulevard, Delray Beach, Florida 33484, NME Properties Corp. 3820 State Street, Santa Barbara, CA 93105 and CT Corporation System, 1200 S. Pine Island Road, Plantation, Florida 33324 on this _oY day of Deruenbely 2001. Copies furnished: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive Suite 100 W. Palm Beach, Florida 33407 Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Nursing Home Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 a er OS RET REE OIE AA RE cid Diane Grubbs i Agency Clerk Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (original) rem eee ee WOE te ore ee i Ai ed ae a ac rr

Docket for Case No: 02-000362