3 -t + Dec=17-2001 82:15pm Frome T-118 P.02/ - 002/019 F486 be oB- 7ob/ STATE OF FLORIDA > AGENCY FOR HEALTR CARR ADMINISTRATION“ /£p i STATE Of FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. ABCA WO. 08-01-0020 NE BEVERLY ENTERPRISES, FLORIDA, INC., d/b/a BEVERLY HEALTE & REHAB ENGLEWOOD, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA"), by and through the undersigned counsel, and files this administrative Complaint against Beverly Enterprises Florida, Inc., d/b/a/ Beverly Health & Rehab Englewood (hereinafter “ Beverly-Englewood”) pursuant to 28- 106.201 Florids 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 a civil penalty in the amount of two thousand one hundred ($2,100) dollars pursuant To Section 400.121 F.S. 3 t Dec=17-2001 02:15on From T=118 P.003/ . - 003/019 Fedge | SORTSDICTION AND VENUE 2. This court has jurisdiction pursuant to Section 420.569 and 120.57 F.S. end Chapter 28-106 F.A.c. 3. Venue lies in this Court, Department of Administrative Hearings, pursuant to 120.57 £.S and Chapter 28 F.A.C. PARTIES 4. BHCA, is the enforcing authority with regard tc skilled nursing fadility licensure law pursuant to Chapter 400, Part If, 8.5. and Rules 594-4 F.A.C. 5. Beverly-Englewood is a skilled nursing facility located-at L112 Drury Lane, Englewood, Florida 34224 and is licensed under Chapter 400, Part II, F.S. aad Chapter 59A-4. PLAC. count Tf BEVERLY-ENGLEWOOD FAILED TO PROMOTE CARE IN AN ENVIRONMENT THAT MAINTAINS OR ENHANCES EACH RESIDENT'S DIGNITY 400.022 (1} (n) F-S. CLASS III 6. ACA realleges and incorporates (1) through (5) as if fully set forth herein. 7., Based on observations, resident comments, staft interviews/comments, the facility failed to promote care in an environment that maintains or enhances each resident's dignity and respect in full recognition ef their individuality for 7 of oom mere ' 2 i t fec~1 7-200] 02:16pm From- : T1168 P.004/019 F-486 18 active plus 22 random sampled residents py: (1) by failing to assist the residents to drink liquids provided io residents at meals efter residents requested to drink the liquids; (2) by | failing to assist residents after observing residents struggling te open milk cartons; (3) by failing to respect the privacy of residents needing care; and, (4) by failing to ensure that residents received their meals together to enhance eating. B. Surveyors observed, on 3/5/01 from 12:10 P.M. until approximately 1:00 P.M, 13 residents sitting at tables with milk cartons placed in front of them, but, facility steff did not assist the residents with theix milk until the trays were served at 1 P.M. | 9. Interviews with the Certified Nursing Assistants (“CNA”) on the above date and time, revealed the residents must wait until the residents lunch trays are delivered before the residents can drink their milk. 10. Resident #28 was abserved on the same day at approximately 12:55 P.M., sticking her thumb in the top of the milk Cart opening it, and drinking the entire content of the container from the top of the torn milk carton. i1 At approximately 12:35 P-M., Resident 29 was observed sitting at the table with an unopenes carton of milk in front of her and repeatedly reaching for the milk. A staff person fore or ore ne erp ee 7 ‘ i Dac=17-2001 02:16pm From= T-116 © P.005/019 ; - . F-496 stated, "No, to wait till lunch." And another, a CNA stated, "We i are waiting for another cart of trays.” 12. During inferview at approximately 12:55 P.M., @ ONaA stated, "We bring the residents into the day room at 11:30 for lunch.” The lunch trays arrived at 1:20 P.M. 13. Resident #33 was observed in the Main Dining Room on 3/702 at 5:45 P.M., sitting with three other residents. The three residents were served their dinner. Resident #39 sat and watched the other residents eating- The Resident watened the other residents eating their food. He looked around the dining room at other residents eating supper. The Resident called out to a staff persan asking for some soup and crackers but, the staf person told the Resident that his dinner would be on another cart. 14. Intexzview with the stafz at the above date and time, revealed the Resident's supper tray was on the second food cart and the others residents’ supper trays had been delivered on the first food cart. 15. Resident #40 was observed in the Main Dining Room on 3/7/01 at 5:45 P.M., sitting at @ table with arother resident. The other resident was served her Supper tray but Resident #40 sat and was served her supper 20 minutes later. 16. On 3/5/01, 2, residents, #2 and #31, sharing = room, were noted. Resident #2 received lunch tray at 12:30 P.M., but 7 4 Dec? 7-2001 02:16pm From= T-116 P.006/019 F496 * Resident #31 did not receive lunch tray until 1:30 P-M., at which tame Resident #2 had finished eating lunch. 17. During observation of the lunch meal, on 3/5/01 from 1:03 P.M. until 1:40 P.M., 13 residents and 5 staff were noted in the South Day Room. Also at this time, the lids from the residents! plates were observed sitting upside down on top of 2 of the tables filled with trash and paper debris from the trays, yet, the residents were being fed at these taoles and the staff failed to remove these lids before feeding the residents. 18. On 3/5/01, in the South Dey Room, at approximately 12:30 P.M., Resident #30 was observed sitting in a PVC Lounge Chair which had another resident's name on it printed in big black letters. 19. Based on’ the foregoing, Beverly Health & Rehab Englewood violated 400.022(1) (n) F.S., herein classified as a class III violation, which carzies, in this case, en assessed fine of $700 pursuant to 400.23 (8) (c) Florida Statuves. This is a repeated deficiency from the Annual Survey of 1/26/00. 204 The Respondent was given written notification of the cited deficiency and the time frame for correction. 20m TNT Se remem: gem ee ad 7 Dec=17=2001 O2:18om — From= T-116 P.O07/019 F=496 COUNT II BEVERLY~-ENGLEWOOD FAILED TO PROVIDE SERVICES TO MEET PROFESSIONAL STANDARDS OF QUALITY. 59A-4.1288 F.A.C. (adopting by reference 42 CYR 683.20 (k) (3) (1)) CLASS TIT 21. AHCA realleges and incorporates (1) through (5) as if fully set forth herein- ' : 22. Based on record review, observations and interviews with nurses, an occupational. Therapist (“OT”), a Physical Therapist Aide and a Registered Dietitian ("RD"), the facility did net provide services, as ordered by the physician, concerning the discontinuance of a medication for Resident #3, the application of'a brace for Resident #1 and Resident #8 and the application of ted hose for Residents #4 and #12. 23. Review of Residant #3's physician telephone orders, dated 03/04/01, revealed chat the physician discenrinued the Resident's Vitemin C and Zine. The nurse signed that the erder was received on 3/4/01, and wrote, “noted” on the order. Review or the current 3/01 physician orders, revealed that the telephone order ré discontinue the supplements had been transeribed to the current orders. Review of the 3/01, Medication Administration Record (MAR), revealed that the Sore mene me rR rote pee yer oer Dec17-2001 02:17 on From T7116 P.008/019 = F-49 . : : Vitamin C and Zinc ned been given to the Resident on 3/5/01 at 9:00 A.M. 24. At 3:45 PM, the surveyor showed the erder to 2 nurses | who were working on the evening shift on 3/5/01. They stated, that che day snift nurse "must have missed it" and stated that the nurse whe noted the order shculd have corrected the MAR. They confirmed that the Vitamin C and Zine should not have been given today to the Resident. a 25. Review of the MAR on 3/6/01 at 10:25 A.M., revealed that the evening shift nurse had given the Resident the Vitamin C at 5:00 P.M. on 3/5/01 and the dey shift nurse had given the Resident the Vitamin ¢ and Zinc at 9:00 A.M. on 3/6/01. 26- Interview with the day shift nurse on 3/6/01 at 10:30 A.M., contizmmed that she gave the Vitamin C and Zinc to the Resident that morning, and she stated, that the nurse who took the order off the chart didn't change the MAR so She waS unaware that they had been discontinued. 27. Review of Resident #3's Nutritional Assessment dated 1/8/01, revealed chat the RD had recommended one sccop of Promod {protein powder) twice a day for a pressure sore that had developed. Review of the physician telephone orders, revealed that the Promod was ordered to be given twice a day on 1/17/01. Review of the January 2001 MAR, revealed that the Promed was not documented on the MAR. Further review of the physician eee 2 Dec=17-2001 02:17om Fron : T-118 .009/019 “118 P. F486 telephone orcers in the Resident's record, revealec that there was no order to aisgontinue the Promod. ) ‘og. Interview with the RD on 3/6/01 at 10:35 A.M. revealed | that she had recommended that the Pramod be discontinued on L/1S/0L. She confirmed that the nursing staff should have been giving the Resident the Promod from 1/17/01 until the discontinue order was received from the physician. Interview with the nurse on 3/7/01 at 9:60 A-M., revealed that she had never given the Resident Promod. She stated, that she was not aware of an order for Promod and would check the computer to see if it had been dascontinued. 29. At 11:10 A.M. on 3/7/01, the RD provided the survey team with a list of D/C (discontinue) Orders for Resident #3 that documented the D/C date for the Promod as 1/20/01. 30. Resident #1 was admitted on 12/14/00, with multiple diagnoses and his/her physician orders of 12/14/00, called for a Cash Brace to se applied when up. 31. The Resident was observed on 3/5/01, 3/6/01 and 3/7/01, up in his wheelchair not wearing his Cash Brace- 32. The Resident's treatment record revealed no documentation that the brace was applied during the month of January, February and March. So a ati 4. aaleatan e i ad Dac=17-2001 02:1 Tom From= T-116 = P.010/019 F496 33. On interview the nurse stared that the resident hed been admitted from the hospital with the brace because of lumbar pain. 34. The PT Aide and the nurse added that they had found the Resident’s prace in his closet and the PT Aide added thet she had not peen aware that the resident had a Cash brace. 35, Resident #8 was admitted with multiple diagnoses, which included Cerebral Vascular Accident. ; 36. The Resident's medical record revealed that she had a right hand contracture and her Plan of Care called for, “Soft hand splint to right hand, apply every AM and remove at night" yet the Resident was observed on 3/5/01 and 3/6/01, during the day, without a sight hand splint. 37. On 3/6/01, during an interview, the OT, referring to Resident$8, stated, "Yes the resident is to have a right hand splint on during waking hours.” 38. Resident #12 was admitted with muitiple diagncses, and his physician's order of 11/7/00, called for “Ted Hose every Shift”, yet the resident was observed, on 3/5/01 and 3/06/01, ~ witheut ted hose. 33. On 3/6/01, @uring interview, the nurse, stated, "Yes he has an order for Ted Hose.” But she could not find them in his room. rene a ORE REE MEET Trane Tr EE errr Decr17~2001 02:17pm From THB P.ON/OI9F - : ~496 40. Resident #4 was readmitted on 1/29/01, with multiple diagnoses, including a Left Hip Fracture and her physician orders of 1/29/01 called for "Thigh High Teds", yet the Resident was observed on 3/5/01 and 3/4/01, during the day, without Thigh High Teds. 4l. The Resident's treatment records revealed, that during two days in February, the Resident refused to wear the Thigh High Teds, but. there was no other documentation for the remaining days noting whether the ted hose was applied. 42. During the month of March the Resident's treatment records revealed no documentation that the Thigh High Teds were applied and on 3/6/01 the nurse stated, "The reason why she does not wear the Thigh High Teds is because of left hip drainage." Yet observations on 3/5/01 and 3/6/01, noted the Resident with a dry dressing on her left hip. 43. Based on the foregoing, Beverly — Englewood violated 59A-4.1288 F.A.C., adopting by reference 42 CFR 483.20(k) (3) (id, herein clessified as a class III violation, which carries, in this case, an assessed Zine of $700 pursuant to 400.23 (8) (c} Florida Statutes. This is a repeated deficiency from the Annual Survey of 1/26/00. 44. The Respondent was given written notification of the cited deficiency and the time frame for correcticn. 10 cal Lael es Dace17~2001 02:17pm From T1168 012/019 F496 count Tit BEVERLY - ENGLEWOOD FAILED TO PROVIDE SUFFICIENT NURSING STAFF layp SERVICES TO RESIDENTS. | S9A-4.108(4) F.A.C. CLASS IIT 45, ARCA reelleges and incorporates (1) through (S}) as if fully set forth herein. 46. Based on observation, % residents at the graup interview, 1 individual interview and Certified Nursing Assistant aunterview, the facility failed to provide sufficient nursing staff to provide for prompt assistance/supervision at meals and prompt response to residents’ call izghts for 8 of 18 active residents sampled and 24 random sampled residents. €7. During the group interview, conducted on 3/5/01, 3 of 12 residents in attendance complained that the facility does not have enough staff especially during meal times, evenings and on weekendS and also complained that it takes staff up to 15 minutes te answer call lights. 48. During an individual interview on 3/6/01, a resident stated, "They are short of help, especially on the weekends end when the students are here nothing gets done. They run in and out and sometimes they don't even Say hello or speak. There is one nurse wno is real abrupt. She runs in and says here are your pills and leaves. There are lots of changes in staff." i PONE PERRET ERIN orm Dace17~2001 02:18pm From= T7116 P.018/019 F496 49. Observation on the South Hall, at approximately 9:15 A.M., on 3/6/01, revealed that a call light was on. Ne staff was observed in the hall or at the nurse's station. At 3:58 A.M., @ resident came out of the room and stated, “My roommate needs help. That's why the light is on. It has been sn for quite some time.” At this time a staff person was observed to enter the room. The resident who had come out to the hell also stated, ¥Somerimes it takes a while” and shook his head. 50. Observation, on 3/7/01, at 12:58 P.M., at the South Hall nurses station, revealed a call light ringing for room 203. A nurs® was sitting at the desk, yet as of 1:10 P.M., the call light still remained unanswered. Si. Observation on 3/6/01 at 3:25 P.M-, on the North Wing, revealed an emergency bathroom call bell/light tinging. There were no staff in the hall er at the nurses station. This call bell/light continued to ring for 5 minutes. During this time, a staff person was obsezved in the hallway talking to 4 resident and this staff person walked down the hall and ignored the emergency call bell/light. Subsequently, a second staff person was observed going down the hall and this staff person looked up at the call light and was noted to also ignore the ringing emergency call light/bsll- 52. Observation on 3/7/01 in the South Dining Room at 12:50 P.M., revealed Residents #9, #6, and #33 sitting at their Seem ear Dec=17-2001 02: 180m From T7116 P.014/019 F496 tables with theiz covered lunch in front of them while staff were observed sitting at the tables feeding othez residents. The nurse’s aides stated all the nurses’ aides were feeding other residents and that the aides would get to the residents when they were finished feeding residents. The aides added that the nurses will nelp feed after passing residents’ medications. 53. On 3/5/01, during observation in the South Dey Room, from approximately 12:10 P.M. until 12:25 P.M., Resident #29 was observed drinking and sticking her fingers in another residents orange juice and staff was noted to do nothing concerning Resident £28’s actions- 54. Observaticn on 3/7/01 on the South Hall at approaimately 5:32 P.M., revealed that a meal tray for Resident £34 was still left om the cart after all other trays hed been passed to the residents who ate in their reoms. During interview at approximately 3:50 P.M. a staff person stated, "Everyone is feeding in the rooms. We have to wait till there is someone who can feed her. She probably won't eat anyway." 55. During observation of the lunch meal in the South Day Room on 3/6/01 at 11:55 A-M., 7 residents were observed seated in the dining room waiting for lunch and no staff were observed in the dining room with the residents. Resident 729 wes ohserved pulling apart the centerpiece on the table and dropping the pieces on the floor. RS Resident #38 was seated next to her B wee Dec-17-2001 02:18pm = From- T-116 P.O18/019 F496 and yelling out "hurcy up" over and over. Resident #29 became agitated from the yelling and started swearing at Resident #38. Ne staff were observed in the hall near the day room or &t the nurses station. After approximately 10 minutes, 2 nurse's aide was observed pushing a resident into the dining room. She left immediately and walked back down the hall away from the day room. Residents #29 and #38 continued to argue and the aide did not intervene. 56. At another table, Resident #33 was observed feeding herself with 4 spoon and an aide was seated next to her providing verbal cueing. When the aide left the dining room at 1:35 P.M., Resident #33 had finished eating her meat, and could not reach the remainder of the food on her plete. The Resident Sat with the spoon in her hand for the next 10 minutes and received no verbal cueing or assistance from the aides at the other tables. S?. Surveyors also observed Rasident #33 yelling at the table and reaching out for Resident #29's food and Resident #29 became agitated and told Resident 738 to leave her alone. The staff discussed removing Resident #38 from the room, but since all staf? were observed to be feeding residents, there was no one available to remove the resident from the dining room. The aide whe had been monitoring this table was nov noted to returm to the dining room. err oor a ae Dec-17-2001 02:18pm From- T-116-P.O16/019 = F-406 58. During the lunch meal in the Seuth Day Room on 3/5/01, the trays were delivered at 1:00 P.M. Random sampled Resident #35 was observed sedted in her geri chair with her food placed on the table in front of her and two nurses' aides were seated at the table feeding two other residents. Resident #35 was not fed until 1:30 P.M., when an aide from another table came over to feed her. 59. Resident #36 was also seated at this table and was observed sitting in front of her food and not eating from 1:03 P.M. until 1:30 P.M. The staff did not provide the Resident with verbal cueing during this time or assist the Resident ta eat. At 1:30 P.M., one of the nurse's aides opened the Resident's carton of milk and the Resident drank a few sips and put the milk Garton down on the table. After another 5 minutes, an aide came over from another table told the Resident to take a bite of food and want back to the other table. She then called across the reom to the 2 aides feeding at the table where Resident #36 was eating and told them to cue her. One of the aides then gave the Resident a bite of food and handed her the fork and went back to feeding Resident #11. Residant #36 ate one bite and received no further verbal cueing or assistance. 60. Ac approximately 1:30 P.M., in the South Day Room on 3/5/01, Resident #33 was observed sitting at a table spilling food onto her clothing as she Drought food from her plate to her errr oR Des-17~2001 02:18pm From T1168 P.B17/019 «= F488 mouth. No staff offered any assistance or cueing. The Residenr Was also observed te spill fruit juice on her clothing protector which was not removdd by the staff. 61. The Respondent was given written notification of the cited deficiency and the time frame for correction. 62. Based on the foregoing, Beverly —Englewood violated 5SA-4.108(4) F.A.C., herein classified as a class ITI violation, Which carries, in this case, an assessed fine of 5700.00 pursuant- to 400.23 (8) (c) Floride Statutes. This is a repeated deficiency from the annual survey of 1/26/00. PRAYER FOR RELIEF WHEREFORE, the Plaintiff, State of Florida, Agency for Health Care Administration requests the Court to erder the following relief: A. Enter a judgment in favor of the Agency for Health Care Administration against Beverly-Englewsod on Counts I through TII. “Be Assess against Beverly- Englewood administrative fines of $2,100.00 for the Class III violations in Counts I through ITI, in accordance with Section 400.121 FP.s. Cc. Award the Agency for Health Care Administration reasonable attorney’s fees, expenses, and costs. 16 oar Ree * Dae~17-2001 02:19pm From= T-116 P.018/019 D. Grant such other relief as the court deems is just and*proper. RESPONDENT 18 FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECPIP? 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. i Issued this [Jt N day of December, 2001. x eA TL. PENIS L. GODFREY Y Senior Atrorney Agency for Health Ca Administration FBN: 0158100 525 Mirror Lake Drive Nerth St. Petersburg, FL 33701 (727) 8352-1525 e 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. Mail, postage prepaid, to Michael Allen, Administrator, Beverly F-406 Sy re cree ont See or ge ale a Fy a) Dac-17-2001 02:19pm From T-i18 P.org/o1g Health & Rehab Englewood, 1111 Drury Lane, Englewood, Florida 34224, Beverly Enterprises-Plorida, inc, One Thousand Beverly Way, Fort Smith, Arizona 72913, and by U.S. Certified Mail, Return Receipt No. 2 259 496 230, to Corporation Service Company, 1201 Hays Street, Tallahassee, Florida 32301-2525 on this 1 2 bay of December, 2001. DENNIS L. GODFREY Copies furnished: Michael Allen, Administrator Beverly Health & Rehab. Englewood 1111 Drury Lane Englewood, Florida 34224 (U. S. Mail) Beverly Enterprises - Florida, Ine. One Thousand Beverly Way Fort Smith, Arizona 72519 (U.S. Mail) Corporation Service Company Registered Agent 1201 Hays Street Tallahassee, Florida 32301 (Certified Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration {Inter-office mail) Dennis L. Godfrey, Esquire AHCA - Senior Attorney $25 Mirror Lake Drive North, St. Petersburg, Florida 33701 ~ 18 F486 cre Ere Sama

Docket for Case No: 02-000701