Df 800% CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4918 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH Certified Article Number CARE ADMINISTRATION, 7U0b 4575 1294 2050 yal Petitioner, SENDERS RECORD Enc) vs. AHCA NO: 200283142 “i 4 ee Enews IHS AT CENTRAL PARK VILLAGE, INC., d/b/a INTEGRATED HEALTH SERVICES AT CENTRAL PARK VILLAGE, Res ondent . ae = Pp Fas) = / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint, against IHS AT CENTRAL PARK VILLAGE, INC., d/b/a INTEGRATED HEALTH SERVICES AT CENTRAL PARK VILLAGE, (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500) pursuant to $$ 400.022 (1) (¢), 400.102 (1) (a) and 400.102(1) (d), 400.121(2), and 400.23(8)(b), Fla. Stat (2001) and to assess costs related to the investigation and prosecution of this case, pursuant to § 400.121(10), Fla. Stat. (2001). 2. The Respondent was cited for the deficiencies set forth below as a result of a complaint survey conducted on or about March 22, 2002. Page 1 of 8 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4918 JURISDICTION 3. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. 4. Venue lies in Orange County, Division of Administrative Hearings, pursuant to Section 120.57 Florida Statutes, and Chapter 28- 106.207 F.A.C. PARTIES S. AHCA is the enforcing authority with regard to nursing home licensure law pursuant to Chapter 400, Part II, Florida Statutes and Rules 59A-4, Florida Administrative Code. 6. Respondent is a skilled nursing facility located at 9311 S. Orange Blossom Trail, Orlando, Florida 32837. The facility is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A- 4, Florida Administrative Code. Its license number is 1089096, effective 07/25/2002 through 07/31/2003; its certificate number is 8847. COUNT I RESPONDENT FAILED TO DEVELOP AND IMPLEMENT WRITTEN POLICIES AND PROCEDURES THAT PROHIBIT MISTREATMENT, NEGLECT, AND ABUSE OF RESIDENTS. 42 CFR 483.13(c) (INCORPORATED BY REFERENCE IN FLA. ADMIN CODE R. 59A-4.1288), §$§ 400.102, 400.121(2), 400.23, 400.022(1) (f) Fla. Stat. (2001). CLASS II DEFICIENCY 7. AHCA re-alleges and incorporates (1) through (6) as if fully set forth herein. 8. Based on resident record reviews and interviews the Respondent failed to neglected to obtain necessary care and service of Page 2 of 8 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4918 one sampled resident. Specifically, based on observation, staff and confidential interviews, clinical record reviews, review of emergency medical service records and hospital emergency room admission records, the Respondent failed to ensure that services or care was provided to prevent physical harm for Resident (#1) who was hospitalized with severe heat stroke (hyperthermia) , respiratory failure requiring intubation, intravenous fluids for hydration, and blisters due to exposure to high environmental heat temperatures and sun exposure for an extended period of time. The findings include the following: A. Clinical record review on 3/22/02 at approximately 3:00 PM for Resident #1 revealed the resident was originally admitted to the facility on 4/17/98 with diagnoses of Multiple Sclerosis, Osteoarthrosis, Debility, and Dementia. B. Review of the resident's Minimum Data Set (MDS) dated 1/19/02 identified the resident as having a short term memory deficit and cognitive skills coded at "I" indicating the resident had difficulty with decision making skills in new situations. Activities of daily living revealed the resident was unable to ambulate and was wheelchair bound. Cc. Review of the resident's care plans identified the resident's Needs/Problem/Concerms as follows: a. Safety R/T smoking dated 10/10/01 and updated on 1/17/02. Approaches were identified as follows: i. Staff member to be with resident when smoking. il. Smoking smock to be used. iii. Cigarettes/lighter held at nurses’ station. b. Alteration in thought process R/T Dx. Dementia as evidenced by short-term memory loss and impaired daily decision-making dated 10/10/01 and updated on 1/17/02. Approaches as follows: i. Ask yes/no questions. D. A review of a Safety Evaluation for Unsupervised Smoking assessment form dated 6/19/01 identified that the resident was assessed by the interdisciplinary team as "is able to smoke unsupervised.” E. Review of the scoring system "severe impairment". The form also indicated “evaluation is done quarterly and with significant change in condition." F. Further record review revealed no other evaluations were available in the clinical record. Interview with the Care Plan Coordinator on 3/22/02 at approximately 5:45 PM revealed, "We don't do the form quarterly." G. Review of physician’s notes dated 2/13/02 revealed the following: "Multiple Sclerosis with gradual decline in function- more falls recently- increased memory loss." H. Review of Social Service Progress Notes dated 2/13/02 revealed the following: "Late entry review of quarterly assessment (1/19/02) alert and oriented x 2 with periods of confusion. Continues to display impaired decision-making skills. Resident found on floor several times over past quarter." Page 3 of 8 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4918 L A review of the physician's orders revealed the resident was administered 10 milligrams of Ditropan XL every day for urinary incontinence while at the facility. According to Saunders Nursing Drug Handbook (W.B. Saunders, Publisher, 1998), Ditropan "should not be taken in high environmental temperatures (heat prostration may occur due to decreased sweating)." A "frequent" side effect of Ditropan is noted to be "decreased sweating” according to the drug handbook. H. A review of the local Orlando newspaper revealed that on 3/21/02, afternoon temperatures in Orlando on 3/20/02 reached 87 degrees with the Ultraviolet index 7-9 indicating " 15 minutes in the sun before skin damage occurs." The "feel like" temperature was 88 degrees due to the humidity. I. Observation of the southeast patio on 3/22/02 at 4 PM where Resident #1 was found on 3/20/02, revealed this patio to be uncovered by any type of awning or shade trees. The concrete patio received the direct rays of the sun at this time of day. A water fountain or other source of fluids such as a soft drink machine was not observed in the area of the patio. J. On 3/22/02 at 4:15 PM, a small lady was observed with a washcloth resting on her forehead shading her eyes from the sun. Another cognitively aware resident on the patio at 4:15 PM on 3/22/02 was asked if staff checked residents periodically when they were out on the patio. The resident stated, "No one ever checks on us .. . they (facility) don’t have the staff to take care of residents who they need to care for." L. Interview with the nurse manager in her office on the West Wing at 4:45 PM on 3/22/02 revealed that the resident ate lunch in his room at 12 Noon on 3/20/02. At 12:15 PM, the resident propelled him/her self in a wheelchair to the southeast outdoor patio to smoke cigarettes. J. The nurse manager stated that the resident remained on the southeast patio, which does not have an awning or any other cover, from 12:15 PM until 2:45 PM. K. When staff went to check on the resident and called his name, the resident did not respond. The nurse manager admitted during the interview, "it was hot out there." The staff observed cigarette ashes on the clothes of the resident and the resident was not wearing a smoking smock. The resident was retumed to the facility and administered oxygen. A 911 call was placed to transport the resident to the hospital. L. Interview with a 3-11 nursing assistant took place at 5:30 PM on 3/22/02 in the nurse manager's office on West Wing. She stated that she observed the resident in bed at 3:15 PM on 3/20/02. She stated that the resident appeared to be in a lot of pain. According to the nursing assistant, the resident had a "stroke" as the resident could not talk at that time. M. Review of the nurse's notes on 3/22/02 at approximately 3:00 PM revealed the following: a. 3/20/02 3:00 PM - "Resident was not in his room at the time of the changing of shift. CNA (certified nursing assistant) went looking for resident. He was sitting on the patio unresponsive. Nurse was called to the patio, resident was brought back to room and placed in bed by staff. Resident remained unresponsive, respiratory difficulty noted, resident was placed on O2 at 2liters via nasal cannula. Unable to obtain blood pressure in both arms. Temp.107.0. Respirations 34. 911 called. N. Review of the Emergency Medical Service report revealed the following: 3/20/02 1520 - "Blood Pressure 151/121, Pulse 190, Temperature 107.9. Pt. unresponsive at nursing home. Upon arrival pt. was in bed unresponsive. Initial contact with pt. felt hot. Temp. verified 107.9. Staff at facility states pt. came to room and collapsed into bed. Nursing home staff states pt. is usually responsive. Doctor states pt. had been outside smoking. Doctor states pt. is wheelchair bound and believes pt. had been outside for quite a while. Doctor also states, pt. has had decreasing fluid intake. Ice packs applied to pt. Transported to ER for tx.” O. Review of the Emergency Records revealed the following: b. 3/20/02 1525 - Emergency Physician Record. " Arrived in ED in unresponsive state from NH. Just prior to arrival pt. allegedly collapsed at NH in unresponsive state. Found outside in smoking area fell out of w/c. Unknown downtime. Agonal respirations with vomiting, depressed gag reflex, Tachycardia, Respiratory Failure, Sepsis, and Hyperthermia. Ice pack Page 4 of 8 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4918 to neck, axilla, groin, Cooling blanket from OR. Critical care 45 minutes, pt. intubated, lumber puncture, NGT all done by MD. “Item on the form revealed "if either question #4, 6, or 8 is answered as yes, the resident is evaluated as not able to smoke unsupervised.” Review of question #4 stated "does the resident need assistance entering the smoking area,” the facility documented yes. Other questions on the sheet evaluating the resident's cognitive/memory status identified the resident scored "8" indicating c. Emergency Procedure Note. " Respiratory Failure requiring intubation. Agonal respirations and vomiting. Pt intubated and placed on respiratory support. Admitted and ventilated." d. Critical Care Continuation Record. " Coma, severe distress. Pt. intubated by MD under conscious sedation because of respiratory failure. e. 4:15 PM: " Pt. is oxygenating adequately, B/P stable after fluid challenge. NG tube inserted by MD." f. Nursing Skin Assessment. "Open blisters on right hand and near elbow, left chest with several unopened blisters and red mark on left upper back." g. Caregiver Observation, Assessment, Interventions and Response to Interventions: " On arrival to ER, pt intubated. Temp 106.3 rectally. Foley inserted. IV's x2 fluids infusing without complications. 17:45 Temp 99.5. Awaits bed. Blistering sunburn noted to right arm. h. Nursing Assessment Continuation: 19:30 "Assumed care of pt at 19:00- NG noted to low suction returning dark brown fluid in small amounts- Foley in place 100cc in bag concentrated dark urine. [V NS infusing Iliter/800 infused. Intubated with 7.5 ET tube on vent. VS 97/48, Heart rate 110, resp.16. Abdomen noted to be hard. Blisters noted to R arm areas: 2” x 1.5" opened area below elbow, 1.5" x .75 at elbow open, .75" x .5" open on elbow. Right forearm unopened blisters: 0.25" round, 1" x 1.25", 1" x .75" above elbow, 1" x 0.75" elbow, 2.5" reddened skin above R elbow with described blisters above, 9.5" area below shoulder R arm noted 4 unopened blisters." 20:00 VS B/P 90/49, Pulse 103. 20:30 B/P 102/61, Pulse 104. 21:00 B/P 100/54, Pulse 104. Output 250ce dark concentrated urine." P. Observation of Resident #1 on 3/22/02 at approximately 1:45 PM, in the Intensive Care Unit at the hospital identified the resident to be on a ventilator for assistance with breathing, a naso-gastric tube was attached to suctioning and intravenous fluids were infusing. The resident's right arm was bandaged and interview with the resident's nurse revealed "the resident has many opened and unopened blisters to various areas." The resident was unable to be interviewed. 9. Based upon the forgoing, the Respondent violated 42 CFR 483.13(c), which requires the Respondent to develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property. Fla. Admin Code R. 59A-4.1288 implements §§ 400.102, 400.121(2), 400.23, 400.022(1) (2) Fla. Stat. (2001), and incorporates by reference 42 CFR 483.13. In addition, based upon the forgoing findings, the Page 5 of 8 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4918 Respondent violated the resident’s “right to receive adequate and appropriate health care and protective and support services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency.” § 400.022(1) (@) Fla. Stat. (2001). 10. The above referenced violation constitutes the grounds for the imposed Class II deficiency and for which a fine of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500) is authorized under §§ 400.022(3), 400.102(1) (a), 400.102(1)(d), 400.121(2), and 400.23(8)(b), Fla. Stat. (2001). 11. This violation also constitutes the grounds for the assessment for costs related to the investigation and prosecution of this case, pursuant to § 400.121(10), Fla. Stat. (2001). CLAIM FOR RELIEF WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Count I, B. Impose a fine of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500) for the violation cited in Count I against the Respondent under §§ 400.102(1) (a), 400.102(1)(d), 400.121(2), and 400.23(8)(b), Fla. Stat. (2001), Cc. Assess costs related to the investigation and prosecution of this case, pursuant to § 400.121(10), Fla. Stat. (2001). Page 6 of 8 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4918 NOTICE The 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 Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the attention of Joanna Daniels, Assistant General Counsel, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #3, Tallahassee, FL 32308. 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, FL Bar #0118321 Assistant General Counsel Agency for Health Care Administration 2727 Mahan Dr., MS #3 Tallahassee, FL 32301 (850) 922-5873 Fax (850) 413-9313 CERTIFIED ARTICLE NUMBER 7106 4575 1294 2050 4918 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a copy hereof has been furnished to Administrator, Integrated Health Services At Central Park Village, 9311 South Orange Blossom Trail, Orlando, Florida 32837, Return Receipt No. 7106 4575 1294 2050 4918 by U.S. Certified Mail, on August / , 2002, C4 (LE, J na Daniels Copies furnished to: Eloise Abrahams, Administrator Integrated Health Services At Central Park Village 9311 South Orange Blossom Trail Orlando, Florida 32837 (U.S. Certified Mail) Wendy Adams Joanna Daniels Agency for Health Care Agency for Health Care Administration Administration 2727 Mahan Drive, MS #3 2727 Mahan Drive, MS #3 Tallahassee, FL 32308 Tallahassee, FL 32308 (Interoffice Mail) (File Copy) JD/sr Page 8 of 8

Docket for Case No: 02-003606