STATE OF FLORIDA IG py AGENCY FOR HEALTH CARE ADMINISTRATION’. be AGENCY FOR HEALTH CARE He ADMINISTRATION, 6 )- JY) Petitioner, AHCA No.: 2002045192 v. 2002037231 Return Receipt Requested: ST. ANNE’S NURSING CENTER, ST. 7000 1670 0011 4846 3503 ANNE’S RESIDENCE, INC., d/b/a 7000 1670 0011 4846 3510 SAINT ANNE’S NURSING CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against St. Anne’s Nursing Center, St. Anne’s Residence, Inc., d/b/a Saint Anne’s Nursing Center (hereinafter “Saint Anne’s Nursing Center”), pursuant to Chapter 400, Part II, and Section 120.60, Florida Statutes (2001) (hereinafter “Fla. Stat.”), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $2,500.00 pursuant to Section 400.23(8), Fla. Stat., for the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Saint Anne’s Nursing Center, pursuant to Section 400.23(7) (b), Fla. Stat. JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.Cc. 4, Venue lies in Miami-Dade County, pursuant to Section 400.121(1) (e), Fla. Stat., and Rule 28-106.207, Florida Administrative Code. PARTIES 5. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, Part II, Fla. Stat. and Chapter 59A-4 Florida Administrative Code. 6. Saint Nursing Center operates a 240-bed skilled nursing facility located at 11855 Quail Roost Drive, Miami, Florida 33177. Saint Anne’s Nursing Center is licensed as a skilled nursing facility; license number SNF1515096; certificate number 8805, effective June 4, 2002. Saint Anne's Nursing Center was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I SAINT ANNE’S NURSING CENTER FAILED TO ENSURE THAT A RESIDENT WAS PROVIDED A WELL-FITTING WHEELCHAIR IN AN ATTEMPT TO ACCOMMODATE HIS/HER INDIVIDUAL NEEDS AND PREVENT INJURIES Title 42, Section 483.15(e) (1), Code of Federal Regulations And Rule 59A-4.1288, Florida Administrative Code (QUALITY OF LIFE) CLASS II DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 8. Because Saint Anne’s participates in Title XVIII or XIX, it must follow the certification rules and regulations found in 42 C.F.R. 483, as incorporated by 59A-4.1288 F.A.C. 9. During a complaint investigation conducted on 6/04/02 and based on observation, interview and record review, the facility did not ensure that a resident was provided a well-fitting wheel chair in an attempt to accommodate his/her individual needs and prevent injuries of one of two sampled residents (#1). 10. Review of sampled resident # 1 medical record revealed that the resident was admitted to the facility on 6/13/00 with the diagnoses of Muscle Weakness, Convalescence Following Surgery, Multi Rehab, ASHD, LTC, UTI, Colostomy, Pruritis, and Falls. On 6/1/02 (Saturday) per staff interview, a nursing assistant found a large bruise on the resident's right breast area. The bruise was of unknown origin and the physician was called. 11. Review of the care plan dated 5/29/02 revealed that the resident was described as having impaired communication with the ability to sometimes understand others and sometimes making self understood. Interview with the Director of Rehabilitation on 6/4/02 revealed that on 5-31-02 he/she noticed that the resident had slumped down in her wheelchair in the dining room, and was subsequently repositioned by staff and that the wheelchair was too tight. He/she told the staff to monitor the resident's behavior of slumping down in the chair. He/she stated that based on the Occupational Therapist (OT) screening on 5/8/02, the resident's wheelchair was determined to fit properly and was the correct size. However, review of the screening did not indicate that the wheelchairs’ size was assessed. The recommendation was to provide a standard wheelchair having standard leg rests with a soft wedge poppel. The positioning recommended was to elevate bilateral lower extremities with a pillow under leg. 12. The Director of Rehabilitation further reported that on 5/31, he/she noticed the wheelchair appeared to be too tight. The arm rests were high and parallel to the breasts and the resident's breast was hanging over the side of the armrest. He/she also stated the bruises matched exactly with the armrests. Upon review of the resident's weight history, the resident had gained approximately 6 pounds in one month (weighed 128 pounds on 4/3/02 and 134 pounds on 5/8/02). Review of the care plan dated 2/19/02 and updated 5/14/02 revealed that the resident was above the Basal Metabolic Index (BMI), which reflects that he/she is overweight with the short-term goal of gradual weight loss toward BMI range by 8/14/02, 13. Further review of the resident's medical record revealed that he/she was also described as having a broad torso. The wheelchair that the resident was given by the facility was 18 inches in width. However on 6/3/02, only after being found in an slumped position by the Director of Rehabilitation on 5-31-02 and noticing that the wheel chair was too tight was the resident provided with a wider wheel chair (20 inches) with cushion that has a hump in the middle to prevent sliding forward to meet his/her needs. Further interview revealed that from 5/8-5/31 staff failed to identify the problem with inappropriateness of the wheelchair's size. 14, In addition, review of the occupational therapy progress note of 6/3/02 revealed that the OT had reported that there was "bruising on the right breast, noted the right breast to be tightly resting on the right wheelchair armrest, slight increase in weight, therefore, wheelchair too narrow now. Provided with wide wheelchair with calf pad and pillow under knees, able to sit comfortably and patient stated 'I feel better now’. Nursing notified." 15. Review of the resident's MDS quarterly assessment of 2/18/02 and an updated care plan dated 2/23/02, revealed that the resident needed total assistance with all his/her Activity of Daily Livings (ADLs). Review of the care plan for potential for skin breakdown, updated on 2/23/02, revealed that the resident was described as being desensitized to pain/ pressure/ discomfort. The short-term goal was described as providing early interventions with all skin issues to minimize the complications of potential skin breakdown over the next 30 days. Some of the approaches listed were to turn and reposition at least every 2 to 3 hours, use positional devices as needed, such as pillows and foam wedges, to prevent bony prominences from direct contact with one another, and a cushion on the wheelchair to reduce pressure. Although the facility was aware that the resident was desensitized to pain/ pressure/ discomfort and was at risk for skin breakdown, it failed to ensure that the appropriateness of the wheel chair's size was taken into account ag a prevention measure, especially during the period of time when the resident had gained weight. 16. Observation of the resident's right breast area by the surveyor in the company of the DON and nursing assistant on 6/4/02 at approximately 3:30 p.m. revealed a very large dark purplish discoloration covering the resident's right breast mostly on the right side and underneath the breast, as well as, on the resident's right torso, underneath the armpit. In addition, there was some yellowish discoloration appearing at the top of the bruised area. The resident appeared lethargic and was lying in bed at the time of observation. 17, Based on the foregoing, Saint Anne’s Nursing Center violated Title 42, Section 483.15(e) (1), Code of Federal Regulations, as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as a Class II deficiency pursuant to Section 400.23(8) (b), Fla. Stat., which carries, in this case, an assessed fine of $2,500.00. This deficiency also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). DISPLAY OF LICENSE Pursuant to Section 400.23(7), Florida Statutes, Saint Anne’s Nursing Center shall post the license in a prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to the facility. The Conditional License is attached hereto as Exhibit “aA” CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I. B. Assess an administrative fine of $2,500.00 against Saint Anne’s Nursing Center, pursuant to Section 400.23(8) (b), Fla. Stat. Cc. Assess and assign a conditional license status to Saint Anne’s Nursing Center, pursuant to Section 400.23(7) (b), Fla. Stat. D. Award the Agency for Health Care Administration costs related to the investigation and prosecution of the case, in accordance with Section 400.121(10), Fla. Stat. E. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Manchester Building, First Floor, 8355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Nelson E. Rodney. 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. elson E. Rédney Assistant General Counfel Agency for Health Care Administration Florida Bar No. 178081 8355 N. W. 53 Street Miami, Florida 33166 (305) 499-2165 Copies furnished to: Diane Lopez Castillo Field Office Manager Agency for Health Care Administration 8355 NW 53° Street Miami, Florida 33166 (Interoffice mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) Skilled Nursing Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) EXHIBIT ‘A” Conditional License License No. SNF1515096; Certificate No. 8805 Effective date: 06-04-2002 Expiration date: 04-30-2003 (pending litigation) €00C/0E/r0 ‘ALVA NOILVUIdXH ASNAOIT 700¢/r0/90 ‘ALVC AALLOdASA NOLLOV asueyD snes “spoq OFT UIA LLIC€ Td ‘INVIN FAL LSOOU TIVNO Sssii ULNA ONISUNN S\ANNV LNIVS :3ULMO][OJ By) aye1ado 0} pezLOyne S} dosuso}] OU Se puke ‘soinjelg ePLOLy ‘TT Wed ‘OOP Joidey ut pezuoune ‘uonensiutupy ae> ypeoH Jo,j Aouesy ‘epuopy jo a1e1¢ 3u) 4q paidope suone|ngaz pur soyns ay) yim pardwios sey ONT SONACISAY % AALNAD ONISUNN S.ANNV LS Jeu) uLyUOD 0} st SINT, “IVNOILLIGNOD ALITIOVA ONISMON GATILIS ALITVNO HLTVaH ONV FaVO CADYNVW AO NOISIAIC NOLLV&LLSININGY FaVO HLTVaH YOd AONADV BPLOL JO 33819 SOOSISTANS ‘# ASNAOIT $088 -+# ALVOMILYAD CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished U.S. Certified Mail, Return Receipt Requested to Administrator, Saint Anne’s Nursing Center, 11855 Quail Roost Drive, Miami, Florida 33177, and to Patrick Fitzgerald, Registered Agent, 110 Merrick Way, Suite 3-B, Coral Gables, Florida 33134 on this 7 ‘< day of October 2002. y Nelson E. Rodney

Docket for Case No: 02-004422