$£.27,2902 2:17PM SHOAL CREEK REHAB WO.722 % 2 ae LA-Y7/ a roe STATE OF FLORIDA AGENCY FOR HWALTH CARB ADNTNZSTRATAGN? L: 09 AGENCY FOR HHALTY CARR ADMINISTRATION, nee Petitioner, ~ ve. AHCA NO. 2002021561 2002043431 NORTH OKALOOSA HEALTH CARE 2002002911 ASSOCIATES, LLC, d/b/a SHOAL CREEK REHABILITATION CENTER, Respondent. / i ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (‘AHCA”), by and through its undersigned counsel, and files this Administrative Complaint against NORTH OKALOOSA HEALTH CARE ASSOCIATES, LLC, D/B/A SHOAL CREEK REHABILITATION CENTER. (“Respondent”)... punsuant..ta. S@GtLn.. 120562)» Ba, 120.57, Florida Statutes (2001), and alleges: Nature of the Action 1. This ig an action to impose an administrative fine upon Respondent pursuant to Section 400,419, Florida Statutes. Jurisdiction And Venue 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. Ser, 24. 2002 2.17PM SHOAL CREEK REHAB NO. 722 P 3, AHCA has jurisdiction over Respondent pursuant to Chapter 400 Part III, Florida Statutes. 4, Venue vests pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 5. AHCA ia the requiatory agency responeible for licensure of nursing homes and enforcement of all applicable Florida laws and rules governing akilled 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, Florida Administrative Code, respectively. 6, Respondent operates a skilled nursing facility in the State of Florida, whose 120-bed nursing home is located at 500- South Hospital Drive; Crestview; Florida: 32539%°~ Respondent’s facility is licensed as a skilled nursing facility license number SNF130471012; certificate number 8507, effective June 12, 2002 through November 30, 2003. Respondent’s facility was at all times material hereto, a licanded facility under the licensing authority of AHCA, and was required to comply with all applicable regulations, atatutes and rules. oc oe 22h 4 2002) 2:17PM SHOAL CREEK REHAB NO, 722 P, COUNT I RESPONDENT FAILED TO DEMONSTRATE RESTRAINTS WERE LEAST RESTRICTIVE MEANS. Bection 400.022 Florida Btatutes (2001) 7. AHCA re-alleges and incorporates by reference paragraphs one (1) through gix (6) above as if fully set forth herein. 8. On or about November 26-29, 2001, AHCA conducted a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: ' Based on observation, interview, and record review, it was determined the facility failed to ensure the use of physical restraints for 3 of 27 sampled residents (#8 2, 19, & 22) was required to treat a medical symptom as evidenced following a comprehensive assessment and care plan. The findings are: Review of the closed record of resident #22 revealed a Minimum Data Set (MDS) asseastiient on 5/23/01 indicating the resident had sustained a fall within the previous 30 days, resulting in a fracture to her hip, Further review of the record indicates the resident sustained a second fall (from the bed) after returning to the fucitity, re-infuring her hip, and consequently required a complete hip replacement. Following her second return to the facility, a MDS assessment completed on 7/3/01 identifies the resident as having a trunk restraint. Review of documentation from a state investigation agency provided evidence of observations by the investigator on 7/17/01 of the resident testrained in bed with a “roll belt tied to the frame of the bed." The inappropriate placement of the roll belt resulted in restriction of movement of the belt and the resident "being bound to the bed." Review of facility records regarding discussion of the resident on 9/11/01 revealed "roll belt applied when in bed. It was improperly used and caused discomfort to the resident.” Interview with facility staff on 11/29/01 at approximately 4:00 PM failed to provide evidence of an assessment to determine the medical necessity of the trunk restraint or a written plan of care indicating the need for the restraint, Observations of resident #19 on all days of the survey, 11/26/01-11/29/01, revealed aresident up most of the day in a wheelchair. The resident was restrained with a front opening lap-belt and positioning was a concer as the resident was often observed slumped down in the chair with the belt riding up towards her chest. Even though the resident did unfasten the belt on 11/25/01 and 2:18PM SHOAL CREEK REHAB NO.722 0 P sustain a fall, the belt was considered a restraint according to the facility Roster/Sample Matrix and interview with staff on 11/28/01 at 3 ‘30 P.M, Further interview with staff and record review revealed there was no restraint evaluation for the restraint, only documentation the facility advised the family of the use of a seat-belt and the physician order for the belt. The facility did not use the Minimum Data Assessment or the Restraint Protocol to assure the need for this type of device, nor was therapy involved in assisting in the evaluation process for an appropriate positioning device or restraint, As a result, there was no aggressive restorative program to reduce the restraint or to return the resident to prior functional ability. Observation of resident #2 on all days of the survey revealed the resident to use a front opening lap-belt when up in the wheelchair. There was only a physician's order and a notation that family was made aware of the restraint. There was no evaluation for the use of the restraint or an assessment process to assure it was an appropriate device. The surveyor toured the therapy department and spoke to staff about resident's #2 and #19 on 11/28/01 at 1:30 PM, Based on this interview, it was revealed staff in therapy had not been involved in assessing either of these residents for the use of restraints or positioning devices, 9. The facility was given a mandated correction date of December 29, 2001. 10. On or about January 2-3, 2002, AHCA conducted a 5 follow-up survey at Respondent's facility. AHCA cited: Respondent based upon the findings below: Based on surveyor observations, record review and staff interviews, three of fourteen (#1, 3 & 4) sampled residents had restraints applied without staff first determining if those restraints were the least restrictive to treat medical conditions. Findings include: Resident #4 was observed on 1/2/02 at 10:15 AM in her wheelchair, with a seat belt applied. The resident was asked by nursing staff and surveyor at this time if ghe could release her seat belt. The resident could not release the seat belt. The resident was also observed on 1/3/02 at 8:40 AM in her wheelchair with the seat belt applied. The resident had on record an Occupational Therapy Plan of Treatment dated 7-10-01 indicating the resident is to use a wheelchair with a dycem pad, to prevent forward sliding, Based on an interview with the Occupational Therapist at 8:40 AM on 1/3/02, she did not recommend the seat Ser. 27, 2002 2: 13M SHOAL CREEK REHAB NO. 722 P, belt for the resident's use. The resident did have an undated restraint assessment on file, signed by nursing staff, indicating use of the seat belt. The portion of the form for noting use of least restrictive measures in the past indicates "0". 2. Resident #1 had a doctor's order dated 12/20/01 for use of a lap buddy in wheelchair due to poor balance. The resident was observed on 1/3/02 at 8:40 AM in the day room with a lap buddy applied. The resident did have an undated restraint assessment on file, signed by nursing staff, indicating use of the lap buddy while in the wheelchair due to poor balance and risk for falls. The portion of the form for noting use of least restrictive measures in the past indicates "0". Based on interview with the Occupational Therapist on 1/3/02, she would be the staff person to assess residents for use of lap buddies, but she had not, as there had been no referral to her for such an assessment. 3, Resident #3 had a doctor's order dated 12/20/01 for use of a lap buddy in wheelchair dus to poor balance, The resident did have an undated restraint assessment on file, signed by nursing staff, indicating use of the lap buddy while in the wheelchair due to "unsuccessful transfer attempts", The portion of the forra for noting use of least restrictive measures in the past indicates "0", Based on interview with the Occupational Therapist on 1/3/02, she would be the staff person to assess residents for use of lap buddies, but she had not, as there had been no referral to her for such an assessment, 11, Based on all of the foregoing, Respondent violated Section 400.022 Florida Statutes (2001), by allowing restraints to be applied without etaff first determining if those restraints were the least restrictive to treat medical conditions, 12. Pureuant to Section 400,23(8) (a), Florida Statutes, the foregoing is a clase III deficiency because the agency determines it will result in no more than minimal physical, mental, or paychosocial discomfort to the resident or has the potential te compromise the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by SE. 27, 2908 2:18PM SHOAL CREE REHAB NO. 722 P an accurate and comprehensive resident assessment, plan of care, and provision of services, A class LIT deficiency is subject to a civil penalty of $1,000 for an isolated deficiency, $2,000 for a patterned deficiency, and $3,000 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class TIT or class II deficiencies during the last annual inspection or amy imapection or complaint investigation since the last annual inspection. A citation for a class III deficiency must specify the time within which the deficiency is required to be corrected. Tf a claga III deficiency is corrected within the time specified, no civil penalty shall be imposed. AHCA is authorized to impose a fine against Respondent in the amount oF $2; O00 CLAIM FOR RELIEF WHEREFORH, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $2,000.00. c) Any other general and equitable relief as deemed appropriate. SER. 27. 2009 2:19PM SHOAL CREEX REHAB NO, 722 P, 8 COUNE Iz RESPONDENT FAILED TO PROVIDE APPROPRIATE CARE TO PROMOTE WOUND HEALING. 42 CFR §483.25 (2001); Rule 59A-4.1288, Fla, Admin. Code’ (2001) 13. AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein. 14. On or about January 2-3, 2002, AHCA conducted a follow-up survey at Respondent’s facility. A class If deficiency was cited against Respondent based on the findings below: Based on record review, observation and staff interviews for 1 of 14 residents (#6) the facility failed to ensure that the resident received necessary nursing and dietary treatment to promote healing of pressure sores, Findings include: Observation of dressing change performed orr t:3-02-at Orta: by a ticensed” practical nurse, revealed that current ordered dressing change is not being followed. The current dressing change order (dated 12/11/01) calls for wet to dry after cleansing with normal saline. The nurse was observed to cleanse with normal saline, packed wound with gauze and covered the wound with an occlusive dressing, Interview with Director of Nursing on the afternoon of 1-3-02 confirmed the order dated 12-11-01 is the current order to be followed for dressing changes, ~ 2, Based on review of clinical dietician notes dated 11-26-01, a recommendation was made to provide the resident with Vitamin C and Zinc supplements, to promote wound healing, However (based on physician's notes) orders to incorporate this treatment were not obtained until 12-5-01, Further dictary teconunendations on 12-18-01 were made to increase the resident's tube feeding from 63 CC per hour to 85 CC per hour, to increase caloric and protein intake, to promote wound healing. Record review revealed orders to increase the rate of the tube feeding were not obtained from the physician until 12-27-01. SEF. 27 2002 2:19PM SHOAL CREEK REHAB NO.722 0B 3. Review of nursing notes dated 12-20-01 document the wound was "undermining @ (position of) 12 o'clock 1 cm", Measurement taken by the licensed practical nurse during observation on 1-3-02 documented 2 centimeter undermining, which indicates worsening of the pressure ulcer, based on previous measurements documented in the clinical record. The Director of Nursing performed dressing change on resident at 2:20 p.m. on 1-3-02 and the following measurements were taken: depth-1.5 centimeters, width-3.1 centimeters, length-3.2 centimeters, undermining-2.3 centimeters, confirming worsening of the wound. 4. Based on clinical record review, on 1-2-02 an order for surgical consult to assist with wound healing was obtained for this resident. 15. Based on all of the foregoing, Respondent violated 42 CFR § 483.25(¢c) via Rule 59A-4.1288, Florida Administrative Code (2001), by failing to provide appropriate care to promote wound healing for a resident 16. Pursuant to Section 400,23(8) (b), Florida Statutes, the foregoing is a class II deficiency because it compromises the residents’ ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision.oaf. services. A,clasa.Il, deficiency ia. subj}ecat..t0. a civil penalty of $2,500 for an isolated deficiency, $5,000 for a patterned deficiency, and $7,500 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the faeility was previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint inveatigation since the last annual inspection. A fine Se? 27,2002 2:19PM SHOAL CREEK REHAB NO, 722 P, shall be levied notwithstanding the correction of the deficiency. AHCA is authorized to impose a fine against Respondent in the amount of $5,000.00. CLAIN FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $5,000.00. c) Any other general and equitable relief as deemed appropriate. COUNT IIT RESPONDENT FAILED TO PROVIDE BLADDER TREATMENT TO A RESIDENT WITH AN IN-OWHLLING CATHETER AFTER ITS USE WAS NO LONGER JUSTIFIED, 42 CFR §483.25 (2001); Rule 59A-4.1298, Fla, Admin. Code (2001) 17. AHCA re-alleges and incorporates by reference Paragraphs one (1) through six (6) above ag if fully set forth herein. 18. On or about November 26-29, 2001, AHCA conducted & survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review, observation and interview, it was determined the facility failed to restore as much normal bladder function as possible for 3 of 27 sampled residents (#1, 7, & 17). The findings are: Record review for Resident #1 indicated the resident was admitted on 7/23/01 with a catheter, The catheter remained in place until 11/17/01 at which time it waa discontinued by nursing, The record lacked evidence of a diagnosis for the catheter, or a doctor's order to discontinue it. The resident was assessed as 2:20PM SHOAL CREEK REHAB NO. 722 P, incontinent of the bladder. The record also lacked evidence of attempted re- training. Record review for resident #7 indicated the resident was admitted on 2/26/01 with a catheter. The catheter remained in place until 11/19/01 at which time it was discontinued by nursing. The record lacked evidence of a diagnosis for the catheter and a doctor's order to discontinue it. The resident was assessed as incontinent of the bladder. The record also lacked evidence of attempted bladder re-training. Interview with the resident on 11/27/01, who is alert and oriented, stated his catheter was removed about 2 weeks ago without any re-training, He/she stated “They just put diapers on me.” Record review for Resident #17 indicated the resident was admitted on 10/5/01 with a catheter, Observation on 11/28/01 at 12:00 noon revealed the resident currently has a catheter. The record lacked evidence of a diagnosis for the catheter, The resident was assessed to be incontinent of the bladder. The record also lacked evidence of bladder re-training attempted, Interview with staff on 11/29/01 at 11:15 AM indicated the reason for the catheter was because she was Hospice. 19. The facility was given a mandated correction date of December 29, 2001. 20, On or about January 2-3, 2002, AHCA conducted a follow-up survey at Respondent's facility, AHCA cited Respondent based’ upon the firdings Below: Based on record review and staff interview one of sixteen (#3) residents did not receive services to restore normal bladder function after the use of an indwelling catheter was no longer justified. Findings include: Review of the clinical record for resident #3 indicates an indwelling urinary catheter was inserted February 2001. The resident had a bowel and bladder assessment dated 12/30/01 indicating use of a foley catheter due to "terminal condition to maintain comfort due to lack of mobility." Based on the current Minimum Data Set (dated 10/01) the resident has no wounds. The resident was observed to be in the dining room at lunch on 1/2/02 and 1/3/02, eating without any indication of discomfort. The Director of Nursing stated in an interview on the afternoon of 1/2/02 that there was no further justification for use of the foley catheter. 7 SEP, 27.2002 2:20PM SHOAL CREEK REHAB NO. 722 P, 21. Based on all of the foregoing, Respondent violated 42 CFR §483.25(d) (2) via Rule 59A~4,1288, Florida Administrative Code (2001), by failing to provide bladder treatment to a resident with an in-dwelling catheter after its use was no longer justified. 22. Pursuant to Section 400,.23(8) (a), Florida Statutes, the foregoing is a class III deficiency because the agency determines it will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident’s ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, aa defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class IIT deficiency ie subject toa civirk-- penalty of. $b)000-~ for an tgohatbede deficiency, 82,000 for a patterned deficiency, and $3,000 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility waa previously cited for one or more class I or class IZ deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A citation for a alaas III deficiency must specify the time within which the deficiency is requived to be corrected. If a class III deficiency ig corrected within the time “SEP, 27.2002 2:20PM SHOAL CREEK REHAB NO, 722 P, 43 specified, no civil penalty shall be imposed. AHCA is authorized to impose a fine against Respondent in the amount of $2,000, CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $2,000.00. ¢) Any other general and equitable relief as deemed appropriate COUNT IV RESPONDENT FAILED TO PROVIDE APPROPRIATE PHYSICIAN SERVICES TO ITS RESIDENTS. 42 CFR $483.40 (2001); Rule 59A-4.1288, Fla. Admin. Code (2001); Rule 59A-4.107 Fla. Admin. Code (2001) 23. AHCA re-alleges and incorporates by reference paragrapha one (1) through gix (6) above aa iff fully set farth herein. 24. On or about November 26-29, 2001, AHCA conducted a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on interview and record review, it was determined 2 of 27 sampled resident (#7 & 14) were not seen by their physicians at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter. The findings are: SEP, 27, 2002 2:20PM SHOAL CREEK RERAB NO, 722 P. {4 Resident #14 was admitted to the facility on 6/19/01. Review of her clinical record revealed evidence of physician visits with documented progress notes on 7/26/01 and again on 10/17/01. Record review for Resident #7 indicated the physician visited on 4/30/01 and not again until 9/1/01. Interview with nurse on 11/26/01 indicated the physician usually visits timely, 25. The facility was given a mandated correction date of December 29, 2001, 26. follow-up On or about January 2-3, 2002, AHCA conducted a survey at Respondent’s facility. AHCA cited Respondent based upon the findings below: Based on record review and staff interview, five of 14 sampled residents were not seen by their physician at least once every 60 days and one resident (#7) was not seen by the physician every 30 days for the first 90 post- admission. Findings include: 1. 27. Resident #3 was admitted to the facility on 1/25/01. Upon record review on 1/2/02, the last physician (MD) visit was 10/10/01. In an interview on 1/2/02, the Director of Nursing (DON) stated no other physician visit had been conducted in between these dates. Resident #4'was adinitted’to the facility on 10/18/00; ‘Based’ on recétd review, physician visits were conducted 7/16/01 and 1/2/02, Based on interview with the facility DON no other physician visits had been conducted between these dates. Resident #13 was admitted to the facility on 7/5/00.. Thera was no evidence in the clinical record of physician visits between 8/18/01 and 1/2/02. Resident # 10 was admitted to the facility on 5/31/00, Based on record review, conducted on 1/3/02, the last physician visit was documented to be 10/13/01, Resident #8 was admitted to the facility 7/23/01. MD visits to the resident were documented in the clinical record to be conducted on 9/22/01 & 1/2/02, with no other visits in the interim. Resident #7 was admitted to the facility on 10/5/01. The last MD visit documented in the clinical record was 10/31/01. Based on all of the foregoing, Respondent 13 SE° 27.2902 2:21PM SHOAL CREEK REHAB NO. 722 P violated 42 CFR $433.40 (c) via Rule 59A-4.12388 Florida Administrative Code (2001), and Rule 59AR-4,107(6) Florida Administrative Code (2001) by failing to provide its residents timely and appropriate physician services. 28. Pursuant to Section 400,.23(8) {c), Florida Statutes, the foregoing is a class III deficiency because the agency determines it will result in no mere than minimal physical, mental, or peychosocial discomfert to the resident or has the potential to compromise the resident's ability to maintain or reach hig ox her highest’ practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of Gare, and provision of services. A class III deficiency is subject to a civil penalty of $1,000 for an igolated defitekency; $2006. for-a~ pavtemed-deStobeney;~ and: $3000" -- for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or Glass II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A citation for a class III deficiency must specify the time within which the deficiency ig required to he corrected. If a class III deficiency is corrected within the time apecified, no civil penalty shall be imposed. AHCA is 14 SE? 27, 2002 2:21PM SHOAL CREEK REHAB NO. 722 Pp. 16 authorized to impose a fine against Regpondent in the amount of $4,000, CLAIM FOR RELTEY ane WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and jegal findings in favor of AHCA,. b) Impose a fine in the amount of $4,000.00, ¢) Any other general and equitable relief as deemed appropriate couNT_v RESPONDENT FAILED "io PROVIDE ADEQUATE SUPERVISION TO PREVENT RESIDENT INJURY. 42 CFR $483.25 (2001); Rule 593-4,1288, Fla. Admin. Code (2001) 29, AHCA re-alleges and incorporates by reference paragraphs one (1) through six (6) above as if fully set forth herein, 30. On or about February 14, 2002, AHCA conducted a complaint investigation in conjunction with a re-visit at Respondent’ s facility. A class II deficiency was cited against Respondent based on the findings below: Based on observation, record review, and staff interview for 1 of 12 residents (#6), the facility failed to provide adequate supervision to prevent injury to tesident, Findings include: Observation of resident #6 on 2/14/02 at 11:30 A.M., during initial tour of facility revealed large area of purplish-red eccymosis starting directly beneath both eyes and covering an area approximately halfway from eyes to level of mouth, 15 SEP, 27,2002 2:21PM SHOAL CREEK REHAB NO, 7220. Resident was noted to have a small healing wound to bridge of nose with bluish eccymosis and swelling noted to nose, When the surveyor asked what had happened, the resident responded the area did not burt but “sure does look bad.” Record review revealed order dated 12/31/01 for side rails to be up (times 2) while in bed to “define perimeter of bed” and assist with bed mobility, Resident has been care-planned to be at risk for falls and fall risk careplan has been updated as recently as 2/3/02, Resident is not to get out of bed or chair without assistance due to balance problems, unsteady gait, lack of safety awareness, and history of falls. Nursing notes dated 2/9/02 revealed that resident was in bed and had fallen out of bed. Resident is quoted to have said “T rolled out of bed and hit the floor.” Assessment documented swelling to bridge of nose and small % inch laceration, Interview with Licensed Practical Nurse on 2/14/02 at 11:30 A.M. revealed that the resident rolled out of bed on 2/9/02 due to no side rails being up while resident was in bed. Observations were made of resident’s bed and side rails were intact and in working order, Interview with Director of Nursing on 2/14/02 at 12:45 P.M. stated that the side rails were not up as ordered on the night that the resident rolled out of bed. 31. Based on all of the foregoing, Respondent violated 42 CFR § 483.25 (h) (2) via Rule S9A-4.1288, Florida Adminiatrative Code, by failing to exercise adequate supervision to prevent injury to resident. 32, Pursuant to Section 400.23 (8) (b), Florida Statutes, the foregoing igs a class IT deficiency because it compromises the residents’ ability to maintain or reach his or her highest practicable physical, mental, and paychosocial well -being, as defined by an accurate and comprehensive resident asseseament, plan of care, and Provision of services. A class Tt deficiency igs subject to a civil penalty of $2,500 for an isolated deficiency, $5,000 for a patterned deficiency, and $7,500 for a 16 li SEP, 23, 2062 2:22PM SHOAL CREEK REHAB NO. 722 P widespread deficteney. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class IL deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inapection, A fine shail be levied notwithstanding the correction of the deficiency. AHCA is authorized to impose a fine against Respondent in the amount of $5,000.00, CLAIM FOR RELIEF piel ES TEL WHEREFORE, AHCA respectfully requests the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of $5,000.00, c) Any other general and equitable relief ag deemed appropriate, COUNT VI RESPONDENT FAILED TO PROVIDE APPROPRIATH CARE TO PROMOTE WOUNR. HEALING. FoOR..2, RESIDENT... 42. CER, $483.25. 2.00.1). ;- Rule 59A-4.1288, Fla. Admin. Code (2001) 33. AHCA re-allegea and incorporates by reference Paragraphs one (1) through gix (6) above as if fully set forth herein, 34. On or about dune 12, 2002, AHCA conducted a survey at Respondent's facility, A class II deficiency was cited against Respondent based on the findings below: 17 2:22PM SHOAL CREEK REHAB NO, Based on clinical record review, observation and staff interview it was determined the facility failed to provide health shakes with meals and between meals for increased protein to promote healing of multiple pressures sores and failed to provide care and treatment by the therapy department to promote healing pressure sores for 1 of 29 sampled residents (#7), The findings are: Clinical record review indicated resident (#7) was readmitted to the facility on 3/22/02 after receiving a fracture from a fall in the facility on 3/15/02. The resident underwent surgery for the fracture, Upon readmission, the resident was assessed as not having any pressures sores, Record review of the monthly pressure report dated 4/9/02 indicated the resident developed stage 2 pressure areas on both heals measuring 2 centimeters x 3 centimeters for the right heel and 3.1 centimeters x 3.8 centimeters for the left heel. The MDS ( minimum data set ) assessment indicated on 4/10/02 the resident had (1) stage 2 pressure sore and (t) stage 3 pressure sore. Further record review indicated a physicians order dated 5/31/02 for PT (physical therapy) to evaluate left heel with eschar and debride. The record lacked evidence that physical therapy evaluated the resident. Interview with the therapy staff on 6/12/02 at 1:00 PM indicated they never received the orders, The resident developed the pressure areas in-house, the areas worsened from stage 2 to not stageable (eschar) and the resident did not receive PT treatment for debriding. Clinical record review indicated a physician order on 5/2/02 for health shakes with meals and in-between meals to increase caloric intake for wound healing. Observation of meals on 6/10/02 at 1:45 PM, 6:20 PM and 6/11/02 at 8:45 AM indicated the resident didn't receive health shakes. Tray card indicated Pureed diet but did not include order for shakes, The MAR (medication administration record) where shakes are recorded for the month of May lacked evidence shakes were given, The MAR for June indicated health shakes in between meals for increase caloric intake for wounds but was marked out or discontinued without the resident receiving any for that month, Interview with a nurse on 6/11/02 at 10:00 AM indicated that the record doesn't reflect an order to stop the shakes and doesn't. know. why.or wha,stopped.the.shakes... The record lacked. ewidence-tbat. the resident received any health shakes after ordered. 35. Based on all of the foregoing, Respondent violated 42 CFR § 483.25(c) via Rule 59A-4,1288, Florida Administrative Code, by failing to provide health shakes with meals and between meals for increased protein to promote healing of multiple pressure sores, and failed to ofr. 2%, 2002 2:22PM SHOAL CREEK REHAB NG 722 B20 provide the care and treatment of its therapy department to promote healing of pressure sores. 36, Pursuant te Section 400.23(8) (b), Florida Statutes, the foregoing ia a clase II deficiency because it compromises the residents’ ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A clags II deficiency is subject to a civil penalty of $2,500 for an isolated deficiency, $5,000 for a patterned deficiency, and 87,500 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class IT or class II deficiencies during the last’ anmuai-.: imepeetion er cany: inspectiomr= orm complaint - investigation since the last annual ingpection, A fine shall he levied notwithstanding the correction of the deficiency. AHCA is authorized to impose a fine against Respondent in the amount of $5,000.00. CLAIM FOR RELIEF WHEREFORE, AHCA respectfully requeste the following relief: a) Make factual and legal findings in favor of AHCA. b) Impose a fine in the amount of 65,000.00. "EP. 27, 2002 2:23PM SHOAL CREEK REHAB N0.722. ¢) Any other general and equitable ralief as deemed appropriate. Dated: September 26, 2002 Agency for Haalth Care Administration Jo C. Page, E ire, Senior Attorney Pla. Bar. No. 0174629 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 921-0158 (fax) 20 S62. 27. 2902 2:23PM SHOAL CREEK REHAB NG. 722 P NOTICE Respondent, NORTH OKALOOSA HEALTH CARE ASSOCIATES, LLC, D/B/A SHOAL CREEK REHABILITATION CENTER hereby is notified that Respondent has a right to request an administrative hearing purauant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for adminigtrative action are set out in the attached Election of Rights form and explained in the attached Explanation of Rights form. All requests for a hearing shall be sent to AHCA, Jodi c. Page, Esquire, Senior Attorney, Agency for Health Care Administration, 2727 Makan Drive, Building 3, Mail Stop #3, Tallahassee, Florida, 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THH ADMINIATRATIVE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY AHCA. Dated: September 26, 2002 AGENCY FOR HEALTH CARE ADMINISTRATION aie Page, ae Senior Attorney Fla. Bar. No, 0174629 2727 Mahan Drive, MS#3 Tallahassee, Florida 32308 (850) 921-6362 (office) (850) 921-0158 (fax) 21 22 “SEP 97, 2902 2:23PM SHOAL CREEK REHAB NO. 722 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint has been sent by Certified Mail (#7106 4575 1294 2050 3645) to NORTH OKALOOSA HEALTH CARE ASSOCIATES, LLC, d/b/a SHOAL CREEK REHABILITATION CENTER, 500 South Hospital Drive, Crestview, Florida 32539 this 26th day of September, 2002. AGENCY FOR HEALTH CARE ADMINISTRATION To C. Page, ire, Senior Attorney Pla. Bar. No. 0174629 2727 Mahan Drive, MS#3 Tallahassee, Plorida 32308 (850) 921-6362 (office) (850) 922-0158 (fax) 22

Docket for Case No: 02-004171