Lif 3509 re STATE OF FLORIDA ro AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 200107044 PHC-BLOUNTSTOWN, INC. d/b/a PARTHENON HEALTHCARE OF BLOUNTSTOWN, 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 PHC-BLOUNTSTOWN, INC., a/b/a PARTHENON HEALTHCARE OF BLOUNTSTOWN (“Respondent”), pursuant to Section 120.569, and 120.57, Plorida Statutes, and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $2,500 against Respondent, pursuant to Section 400.102, Florida Statutes, and assess costs related to the investigation and prosecution of this case, pursuant to Section 400.121(10), Fla. Stat. JURISDICTION AND VENUE 2. This tribunal has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. Venue shall be determined pursuant to Rule 28- 106.207, 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 c (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 150 bed nursing home is located at 17844 N.E. Crozier Street, Blountstown, Florida, 32424, Respondent is licensed as a skilled nursing facility license #SNF12870961; certificate number 8149 effective January 10, 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. Counr I THE FACILITY FAILED TO ENSURE AND PROVIDE EACH RESIDENT WITH THE NECESSARY CARE AND SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL- BEING, IN ACCORDANCE WITH THE COMPREHENSIVE ASSESSMENT AND PLAN OF CARE. 42 CFR 483.25; RULE 59A-4.109(4) (aa), Fua. Apmin. Cope SECTION 400.23(8) (B), Fua. STAT. ; SECTION 400.102(p), Fua. STAT. ; SECTION 400.121(10), Fua. STAT., AND; RULE 59A-4.1288, FLA. ADMIN. CopE 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. AHCA conducted a survey of Respondent on November 7, 2001. Investigation revealed the following class It deficiency, to wit: a. Record review of Resident #2’s record showed the resident has a diagnosis to include Diabetes. Nursing notes starting on 8/12/01 indicate resident had a red raised rash to body which the resident was scratching until it bled. Nursing notes indicated that rash continued and spread to entire body by 8/30/01. There was no indication the attending physician was notified of the rash and scratching until his visit of 9/4/01. No comfort or palliative measures were provided to alleviate the symptoms of itching and discomfort. 8. Respondent’s failure to ensure and provide each resident with the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being is a violation of 42 CFR 483.25. 9. Respondent’s failure to ensure and provide each resident with the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being is a violation of Rule 59A- 4.109(4) (aa), Fla. Admin. Code. 10. Respondent’s failure to ensure and provide each resident with the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being is a violation of Rule 59A-4.1288, Fla. Admin. Code. 11. The above is a class II deficiency and constitutes grounds for the imposition of an administrative fine of $2,500 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. CLAIM FOR RELIEF —— eee WHEREFORE, the Agency respectfully requests the following relief: 1). Factual and legal findings in favor of the Agency on Count I; 2). Imposition of a $2,500 administrative fine; and Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida 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; Christine Messana, 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. Respectfully submitted. Dated this sf day of Ass uihsova Christine T. Megsana 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) cc: Elizabeth Dudek CERTIFICATE OF SERVICE Sa ATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on this LS £ day of Ac ‘ uc 2002 to: PHC-BLOUNTSTOWN, INC., d/b/a PARTHENON HEALTHCARE OF BLOUNTSTOWN, 17844 N.E, Crozier Street, Blountstown, Florida 32524, (on Christine T. Messana S Wdiacey UN|eYy onSEWOg 0002 eunf ‘| 1eE Woy Sd ‘d30NaS "BY veSTE TA “UMojsyuno]g PONS IBIZOID “AN pPrsLi 4 NMOLS.LNNOT¢ JO FYVOHLIVAH NONAH Ld &/y/P “ONI ‘NMOLSLINNO1Ed-OHd 10) passeippy BONY *t SAT) (883 22x3) Lhanyeg perusey “p WWW G3ldliuaD edél sovues -¢ ON 1 ‘mo|eq Ssemppe Aanep i01U9 "$3, }I 884 21 wen: wo, jusseyP sseuppe Asonnep 6 “