Group STATE OF FLORIDA ; ~2 AGENCY FOR HEALTH CARE ADMINISTRATION, Ay o. AGENCY FOR HEALTH CARE ADMINISTRATION, Patitioner, vs Case No, 2002012921 CORDCVA REHAB, INC. a/b/a NURSING PAVILION at CHIPOLA RETIREMENT CENTER The Respondent. ADMINISTRATIVE COMPLAINT " coisd “NOW “the! AGENCY (FOR HEALTH CARE. ADMINTSTRATION { “HCA” , byand: through the’ undersigned counsel, .and files this Administrative Complaint against the CORDOVA REHAB, INC. d/b/a NURSING PAVILION at CHIPOLA RETIREMENT CENTER, (“Chipola”), pursuant to Section 120.569, and 120.57, Florida Statutes, (2001), and alleges: NATURE OF THE ACTION 1. This is an action toa impose an administrative fine in the amount of $5,000 againat Chipola, pursuant to Section’ 4002102, Florida Statutes, (2001) and. 48s8es8 costs related to ‘the’ ‘investigation - ‘arid prosecution. of this cage, pursuant “te Section 4087. 121 (10), Flav-stat, -(2902),.. T-O2; 1O:CGAM;Oe@:0a Health Group JURISDICTION AND VENUE jurisdiction pursuant to 2. This txibunal has Sections 120.569 and 120.57, Florida Statutes, (2001). 3. ‘Venue shall be determined pursuant to Rule 28- 106.27, Florida Administrative Code. PARTIES 4, AHCA is the regulatory agency responsible for i ment of all licensure of nursing homes and enforcemen applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant. to the Omnibus Reconciliation Act of 1987,Title IV, Subtitle C (as amended); Chapter 400, Part IZ, Florida Statutes, (2001), and; Chapter 598-4 Fla. Admin. Code, respectively. 5. Chipola is a skilled nursing facility whose 60- bed nursing home is located at 4254 Third Ave., Marianna, Plorida 32446. Chipola is licensed to operate a skilled muraing faeility license #SNF13730962; certificate number 7793) effective 10/25/01 through 10/25/02. At all relevant times, Chipola was a licensed facility required to comply with all applicable regulations, statutes and rules under the licensing authority of AHCA, COUNT I CHIPOLA COMPROMISED ITS RESIDENTS’ ABILITY TO ATTAIN OR MAINTAIN THEIR HIGHEST PRACTICABLE WELL-BEING BY FAILING TO PROVIDE RESIDENTS WITH SUFFICIENT FLUID INTAKE TO MAINTAIN PROPER HYDRATION AND HEALTH; DENYING RESIDENTS THEIR RIGHT TO RECEIVE ADEQUATE AND APPROPRIATE HEALTH CARE AS CGaM;Daite Mealct a Group ESTABLISHED BY COMMUNITY AND WITH R TO PROVIDE PROPER HYDRATION IS PRACTICE STANDARDS IN THE THE AGENCY. THE FAILURE A NEGLIGENT ACT THAT LITY RESIDENTS IN RECOGNIZED ULES ADOPTED BY HEALTH OF FACI MATERIALLY AFFECTS THE VIOLATION OF ‘THE STATUTES HOMES. 6. AHCA 42 CFR 483.25 (3) Section 400.23(8)(b), Fla. Stat. Section 400.022(1) (1), Fla. Stat. Rule S9A-4,1288, Fla. Admin. Code Beaction 400.102.1) (a), Fla. Stat. Section 400.102.1) (d), Fia. Stat. ye-alleges and incorporates paragraphs through (5) as if fully set forth herein. 7. September 4-6, AHCA conducted a re-certificati Clasa II deficiency, to wit: a). Resident #6 was admitted to the hospital on based on the resident’s physician’s diagnosis of fecal impaction and fever on 4/27/01. The physician’s admitting examination noted the resident’s mucosa was dary. The resident was treated with IV hydration and antibiotics. Resident #6 was readmitted to the nursing home on 5/9/01 with diagnoses of Alzheimer’ s with agitation; abnormally low potassium levels in the blocd; esophageal strictures; depression, and; fecal impaction. b). The initial nutritional assessment of Resident #6 wpon readmission to the nursing home on 5/9/01 after hoapitalization states: that the resident’s: ideal body weight was from 104 ~ 127 pounds; that the resident’s usual weight was 88 pounds; that the resident weighed 83 pounds on re-admission; that the resident needed partial assistance with aating, and; “needs much encouragement” 3 AND RULES GOVERNING NURSING (1) on survey of Chipola 2001, Investigation revealed the following with fluids. The facility determined that the resident, required a daily fluid intake of 1140 cc’s of fluid. c). Review of facility documentation states that the resident was offered fluids 5-3 times a day, but there is no documentation ahowing what, if any, amount of fluids were consumed by the resident. da). On 8/11/01, Resident #6 complained of abdominal pain and the faciliry ataff determined that the resident was suffering from fecal impaction. After disimpacting the resident, the facility notified the physician and Resident #6 was admitted to the hospital on 48/12/01 with diagnoses of urosepsis; dementia, and; constipation. The resident was again treated with IV hydration and antibiotics. e, Review of facility documentation confirmed that Resident #6 had no bowel movements from 8/2/01 - 98/8/01 and only three small bowel movements from 8/3/01 - 8/11/01, with disimpaction occurring on B/11/01. £)- Review of the resident care plan dated 8/27/01 listed assesament for signs and symptoms of dehydration; providing preferred beverages; keeping beverages mearby in the resident’s room; inviting resident to activities that promote food and fluid intake, and; to encourage the resident to consume food and fluids from the snack cart twice daily or as needed. £). During the survey on. September 4-6, Resident #6 was observed wandering through the halls without any liquide dn hand. During lunch on 3/4 Resident #6 waa observed to have consumed only 50% of .a glass of milk, the only liquid on the tray, and no other liquids were offerad by the facility. Dinner observation on the sama day showed the resident consumed only about 10% of the deed tea that was offered. g).- Review of nurses’ notes from May to September show only sporadic assessment of hydration status. Review of the facility intake decuments for Resident #6 show that the facility did not keep track of the resident’s fluid intake for the entire month of August when Resident 6 suffered the second incident of fecal impaction and hospitalization, 8. Failure to provide sufficient fluid intake to facility residents violates 42. CFR 483.25(j). That failure to ensure ‘proper hydration compromised the vesident’s ability to attain, or maintain,.the highest practicable level of well-being; a Class II violation subject to a civil penalty of $5,000 under Section 400.23(8) (5), Fla. Stat., (2001). The failure to properly hydrate facility residents constructively denied the resident’s the right to receive adequate and appropriate health care under Section 400.022(1)(1), Fla. Stat. (2001). Failure te ensure Proper hydration of facility regidents is a negligent act that materially affects resident health and violates the statutes and rules governing nursing homes; grounds for the administrative fine under Sections 400.102.1) (a) &({1) (ad), Fla. Stat, (2001) and Rule 59A=4.1288, Fla. Admin. Code, respectively. The Agency’s assessment of costs related to the investigation and prosecution of this case ig proper ; . i pursuant fo Section 400.121(10), Fla. Stat. (2001). WHEREFORE, AHCA intends to impose an administrative fine in the amount of $5,000 against the Respondent Chipola, a skilled nursing facility in the State of Florida, pursuant to Section 460.102, ‘Fla. Stat. (2001) and assess costs related to the investigation and prosecution of this case, pursuant to section 400,121(10), Fla. Stat. {2001). 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 Blection of Righta (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 Haalth Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida, 32308; Attention Christine T. Masaana, 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. ed a ee : Respectfully submitted. Dated March 1, 2002. Olas hae. Chriatine T.’ Messana Pla. Bar. No. 0153818 Counsel for Petitioner Agency for Health Care Administration Bldg. 3, MSC#3 2727 Mahan Drive Tallahassee, FL 32308 (950) 922-5873 (office) (850) 413-9313 (fax) a Molly Mckinstry, Donah Heiberg, Agency for Health Care Administration . CERTIFICATE OF SERVICE T HEREBY CERTIFY that a ‘true and correct copy of the foregoing has been served by certified mail on March 1, 2002 to: Cordova Rehab, Inc. d/b/a/ Nursing pavilion at Chipola Retirement Center, 4294 37 Avenue, Marianna Florida 32446 Christine T. Messana

Docket for Case No: 02-003078