95/09/2002 89:56 98594749795 THE HEALTH CENTER PAGE 02/22 mo Rect S/2f 0a. STATE OF FLORIDA *, AGENCY FOR HEALTH CARE ADMINISTRATION /g LB . as ff AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, : OR RAE vs. Case No. 2002012241 THE HEALTH CENTER OF PENSACOLA, INC. d/b/a THE HEALTH CENTER OF PENSACOLA, The Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against THE HEALTH CENTER OF PENSACOLA, INC. d/b/a THES HEALTH CENTER OF PENSACOLA (“Respondent”), pursuant to sections 120.569, “and 120.57, Florida Statutes, and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $10,000 against Respondent, and assess costs related to the investigation and prosecution of this case, pursuant to section 400.121(10), Fla. Stat. JURISDTCTION AND VENUE EXHIBIT 7. 05/8/2082 89:56 8584749795 PAGE 03/22 THE HEALTH CENTER 2. This fribunal hae Jurisdictionu pursuant to sections 120.569 and 120.57, Florida Statutes. 3. Venue shall be determined pursuant to Rule 28- 106.27, Florida Administrative Code. PARTIES 4. AHCA is the regulatory agency responsible for licensure of nursing. homes and enforcement of all applicable federal regulations, state. statutes and rules governing skilled nursing facilities pursuant to the omnibus Reconciliation Act of 1987, Title IV, Subtitle ¢ (as amended); Chapter 400, Part II, Florida Statutes, and; Chapter 59A-4 Fla. Admin. Code, respectively. 5. Respondent is a skilled nursing facility in the State of Florida, whose 180-bed nursing home is located at 8475 University Parkway, Pensacola, Florida 32514. Respondent is licensed as a skilled nursing facility license #SNF14130961; certificate number 8353, effective ‘February 12, 2002. Respondent was at all times material hereto, a licensed facility under the licensing authority of AHCA, and was required to comply with all applicable regulations, statutes and rules. 6. The Agency may assess costs related to the investigation and prosecution of this case, pursuant to section 400.121(10), Fla. Stat. 05/98/2002 89:56 8584749795 THE HEALTH CENTER PAGE Count = THE STABBING OF RESIDENT #1 © VIOLATES THE STATUTES AND RULES GOVERNING NURSING HOMES AND COMPROMISED THE RESIDENT'S ABILITY TO ATTAIN, OR MAINTAIN, THE HIGHEST PRACTICABLE LEVEL oF WELL-BEING, AND DENIED THE RESIDENT THE RIGHT TO BE FREE FROM ABUSE. 42 CFR 483.13 (np); SEcrron 400.102(1) (p), Fua. Star.; Section 400.022(1) (0), Fua. Srar.; Secrron 400.23(8) (ps), Fua. Srat.; Section 400.121(10), Fua- STat., AND; RULE 59A-4.1288, Fua. ADMIN. Cope 7. AHCA re-alleges and incorporates by reference paragraphs (1) through (6) as if fully set forth herein. 8. ABCA surveyors conducted a survey of Respondent’s facility on February 12, 2002. Staff interview, record review and surveyor observation brought to light the following: a. Resident #1 had significant cognitive impairment and an inability. to carry on any meaningful conversation. b. Resident #1 resided in facility’s locked Alzheimer’s unit. e. On, ox about, November 22, 2001, staff weber -R.d. stabbed Resident #1 in the hand with a fork during supper. The stabbing of Resident #1 constituted abuse. 9. Pacility staff stabbing Resident #1 denied the resident's right to be free from physical abuse in 84/22 05/08/2002 ° 89:56 8504749795 THE HEALTH CENTER PAGE as/22 violation of 42 MFR 483.13(b), eection 400.022(1) (0), Fla. Stat. and Rule 59A-4.1288, |Fla. Admin. Code. 10. Facility staff stabbing Resident #1 compromised Resident #1’s ability to malintain, or reach, his or her highest practicable well-beling and is a class II deficiency as defined in section 400.23(8) (b), Fla. Stat. 11. The class II deficiency was an isolated deficiency. Respondent was|previously cited for one or more class II deficiencies at the at conducted March 25 through March 29, 2001. Tha above constitutes grounds for the imposition of an administrative fine of $5,000 pursuant to sections 400.23(8) (b), and 400.102(d), Fla. Stat. . 12. The Agency may assess costs related to the _ investigation and prosecution of this case, pursuant to section 400.121(10), Fla. Stat.. CounT Ir THE FACILITY’S FAILURE TO SUCCESSFULLY IMPLEMENT ITS ABUSE POLICY VIOLATES THE STATUTES AND RULES GOVERNING NURSING HOMES AND COMPROMISED THE RESIDENT’ S ABILITY TO ATTAIN, OR MAINTAIN, THE HIGHEST PRACTICABLE LEVEL |OF WELL-BEING. 42 CFR 483.13 (c) (1) (1): Sectzon 400.102(1)|(p), Fua. Srar.; Sscrton 400.23(8) (5), Fua. Srar.; Secrron 400.121(10)|, Fua. Srar, anv; Rowe 59A-4.1288, Fra. Apmin. Cope 13. AHCA re-alleges and incorporates by reference paragraphs (1). through (12) as if fully set forth herein. 14. During the survey conducted on February 12, 2002, A PAGE @5/@8/ 2082. 69:56 8504749795 THE HEALTH CENTER BRHCD surveyors determined Lhe following: a, Staff member, M.M., stated she haard staff member R.J. tell Resident #1, “If you keep messing with other peoples’ food, I’m going to stick (or stab) you.” M.M. then saw R.J. stab Resident #1 in the hand with a fork. . Yet another staff member (A.B.) stated on the Friday after the incident that R.J. told her that she (R.J.) had stuck Resident #1 because the resident wouldn’t stop reaching into other residents’ plates. .M.M. did mot report the incident, as required by facility policy, for two days.— A.B. did not report the incident, as required by facility policy, for a day. . The perpetrator did not self-report. Neither M.M., nor A.B. called the abuse hotline as required by facility policy and section 415.1034 (1) (A) (4), Fla. Stat. Respondent failed to succesefully implement its abuse policy and the abuse-reporting requirement was violated by facility staff. 15. its abuse Respondent’s failure to successfully implement P iP policy violates 42 CFR 483.13(c) (1) (i) and Rule 59A-4.1288, Fla. Admin Code. 6/22 THE HEALTH CENTER PAGE 07/22 ; a8/@8/2082 89:56 8584749795 16. Respondent’s failure to successfully implement its abuse policy compromised Resident #1’s ability to maintain, or reach, his or her highest practicable well- being and is a class II deficiency as defined in section 400.23(8)(b), Fla. Stat. 17. The class II deficiency was an isolated deficiency. Respondent was previously cited for one or more class II deficiencies at the survey conducted March 25 through March 29, 2001. The above constitutes grounds for the imposition of an administrative fine of $5,000 pursuant to sections 400.23(8) (b), and 400.102(d), Fla. Stat. 18. The Agency may assess costs related to the investigation and prosccution of this case, pursuant to section 400.121(10), Fla. Stat. CLAIM FOR RELIEP WHEREFORE, the Agency respectfully requests the following relief: 1). Factual and legal findings in favor of the Agency on Counts I and II; 2). Imposition of a $10,000 administrative fine, and; 3.) Uphold the assessment of costs related to the investigation and prosecution of this case, _ pursuant to section 400.121(10), Fla. Stat. . Respondent is notified that it has a right to request an administrativee hearing. pursuant to section 120.569, Florida 05/88/2902 , 83:56 8584749795 THE HEALTH CENTER PAGE 48/22 Statutes. 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; Virginia Daire, Agency Clerk. 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. Respectfully submitted. Dated thisKEY day of Ade] , 2002. 4, | Cs thr. Christine T. Messana Fla. Bar. No. 0153818 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive Tallahassee, FL 32308 (850) 922-5873 (office) (850) 413-9313 (fax) ce: Elizabeth Dudek , 05/09/2082. 99:56 8584749795 THE HEALTH CENTER PAGE 09/22 CERTIFICATE OF SERVICE G2 Ji 18 ay ae I HEREBY CERTIrY that a true and correct copy of “thé : CUM: foregoing has been served by certified Wail bh) this Rey day of til, 2002 to: The Health Center of Pensacola, Inc., d/b/a The Health Center of Pensacola, 8475 University Parkway, Pensacola, Florida 32514 ep i Christine T. Messana

Docket for Case No: 02-002790