STATE OF FLORIDA Mi - ~4 AGENCY FOR HEALTH CARE ADMINISTRARIS Pi 3: 56 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Vv. PALM BEACH COUNTY HEALTH CARE DISTRICT d/b/a PALM BEACH COUNTY HOME , Respondent. Ad § ip HE ARIES: AHCA No.: 2002047624 AHCA No.: 2002047625 Return Receipt Requested: 7000 1670 0011 4847 2253 7000 1670 0011 4847 2260 0% 077 ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA” or the YAgency”), by and through the undersigned counsel, and files this administrative complaint against Palm Beach County Health Care District d/b/a Palm Beach County Home (hereinafter “Palm Beach County Home’), pursuant to Chapter 400, Part II, and Section 120.60, Florida Statutes (2001), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $1,000.00, pursuant to Section 400.23(8), Florida Statutes (2001), for the protection of the public health, safety and welfare. 2. This is an action to impose a conditional licensure status effective 08/29/02, pursuant to Section 400.23(7) (b), Florida Statutes. JURISDICTION AND VENUE 3. AHCA has jurisdiction pursuant to Sections 120.569 and 120.37, Florida Statutes Chapter 28-106, Florida Administrative Code. 4, Venue lies in Palm Beach County, pursuant to Sections 120.57 and 121(1) (e), Florida Statutes and Chapter 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, Florida Statutes (2001), and Chapter 59A-4 Florida Administrative Code. 6. Palm Beach County Home operates a 198-bed skilled nursing facility located at 1200 45 Street, West Palm Beach, Florida 33407. Palm Beach County Home is licensed as a skilled nursing home under license number 14030961. Palm Beach County Home 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 PALM BEACH COUNTY HOME CARE FAILED TO ENSURE THAT A RESIDENT WAS FREE FROM INVOLUNTARY SECLUSION AND/OR PHYSICAL RESTRAINT. Title 42, Section 483.13(b), Code Of Federal Regulation, as incorporated by Rule 59A-4.1288, Florida Administrative Code, and/or Sections 400.022 (1) (0), and (3), Florida Statutes. (RESIDENT RIGHTS) UNCORRECTED CLASS III DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 8. The Agency cited Palm Beach County Home with one (1) uncorrected Class III deficiency, pursuant to surveys conducted on July 18, 2002, and August 29, 2002. 9. Palm Beach County Home participates in Title XVIII or Title XIX and therefore must follow certification rules and regulations found in Chapter 42 Code of Federal Regulation 482, as incorporated by 59A-4.1288, Florida Administrative Code. 10. Based on the survey conducted on July 18, 2002 and based on observation, record review, and interviews, w the Agency’s surveyor found that Palm Beach County Home failed to ensure that a resident was free form involuntary seclusion and/or physical restraint. The surveyor determined that the facility neglected to ensure that one resident (#15) of 24 sampled residents was free of involuntary seclusion and/or physical restraint, in that the resident was in a secured room that had a slide bolt on the outside of the door that prevented the resident from exiting at will. Findings include the following, to wit: 11. “During the initial tour on 7/15/02 at approximately 9:45AM on the Held I Unit, a delayed exit unit (for Alzheimer/dementia residents), resident #15 was observed to be in her room. This resident was observed through a rectangular opening at the top of the door which had a "swinging lid" The resident was observed lying face down on the bed. The door to the room had a "slide bolt” on the outside of the door that was in the locked position. Additionally, there was an alarm at the top of the door on the outside. The alarm was disarmed by the nurse so the nurse and surveyor could enter the room. This alarm when not disarmed would go off when the door is opened. The resident did not respond when spoken to by the staff nurse or surveyor. The interior of the room contained a television set that was on a platform that was secured to the ceiling. The floor of the room, all corners/edges of furniture were covered with soft, black padding. This was also done in the bathroom on the sink and handrails. The staff nurse indicated that this resident can be very combative at times and the resident was kept in the room to protect the other residents. 12. Observation during the survey (all 4. days) revealed that the door was locked at all times except during care. When interviewed on July 17, 2002, the administrator stated the door was kept locked because the resident was at times aggressive toward others and attacked staff and other residents. When interviewed on July 17, 2002, the nurse manager of the unit stated the resident's door was kept locked to keep other residents from entering the room to prevent altercations as the resident in the room would hit the intruding residents. Two licensed nurses on the unit were interviewed and asked why the resident's door was locked. One of the nurses on July 17, 2002 said the administrator had told staff the door was to be kept locked at all times. The second nurse, on July 18, 2002, said to talk to the administrator. 13. At 10:10 am on 7/15/02 two surveyors observed resident #15 in her room sitting on her bed; the resident appeared calm. The door was bolted from the outside. wn On 7/16/02 at 3:15 pm the resident was observed to be in his her room. The door was bolted from the outside and the alarm was on. The observation was made through a window in the door. The resident was laying on the padded floor in front of the door he/she appeared to be asleep. On 7/17/02 the resident was observed from 12 noon to 12:45. At 12 noon the door was locked with the bolt, the alarm was on. The observation was made through the window in the door. The resident was walking in the room shaking her head and waving her right arm. When the resident saw the surveyor standing outside the room the resident walked into the bathroom that is in the room. The surveyor continued to observe the end of the hall where the resident's room is, by a mirror mounted to the ceiling, across from the nurses station. Between 12:30 and 12:40 nursing staff went into the resident's room with a geri chair recliner. The nursing staff spoke to the resident in the resident's primary language, Spanish. The resident was observed by the surveyor to be agitated and chasing the staff member out of the room gesturing with her arms as if pushing something out. The resident was observed to be pushing the geri chair out of the room. After the chair was taken away, while the door was still open, the staff showed the resident a tray of food in Styrofoam containers and spoke to the resident in Spanish. The nurse said they were telling the resident what she had for lunch. The resident loudly said "no." The nursing assistant staff member continued to speak to the resident in Spanish while standing near the doorway with the food tray. At 12:45 the resident shouted something and hit the tray and the cups of food went on the floor. At this point the staff backed off, the resident was still in the room. The staff shut the door alarmed and bolted it. After this the resident was quiet in the room. 14. On 7/18/02 the surveyor observed the resident again. The surveyor made observations of the resident, continually monitored the room door looking at the ceiling mounted mirror across from the nurses station from 7:30 am to 10:30 am. From 7:30 to 7:40 am the resident was observed to be asleep on the floor in front of the door. The nurse was asked at this time why the door was bolted from the outside and she stated it was locked when she came on duty and to ask the Administrator why. At 7:40 am the nurse turned off the alarm and unlocked the bolt. The nurse had the resident's breakfast tray, which was in Styrofoam containers. The nurse stayed with the resident cuing the resident to eat more slowly while the resident ate all but a few bites of meat. The resident was calm and cooperative during this time. The resident drank everything. After the meal the nurse left the room alarming it and bolting the door from the outside. At 8:00 am the resident was again lying on the floor in front of the door awake and quiet. At 9 am, a male resident ambulated to the end of the hall. The alarm on the door went off. The nurse and = surveyor responded immediately. The male resident was removed from the area. She stated he had unbolted the door and attempted to open it. The nurse spoke to resident #15 through the window in the door at this time. The resident responded and spoke Spanish to the nurse who told the surveyor that the vesident cursed at her in Spanish. 15. At 9:07 the resident refused his/her medications when they were offered and resident said "no." From 9:07 to 10:30 am the resident was quietly walking or sitting in the chair in the room. 16. The facility Abuse Policy on page 2 of 16 #5 documents the following, "Involuntary seclusion is defined as separation of a resident from other residents or from his/her room against the resident's will, or the will of the resident's legal guardian or representative (sponsor). Temporary monitored separation from other residents will not be considered involuntary seclusion and may be permitted when used as a therapeutic intervention to reduce agitation as determined by the medical director, and or the director of nursing services, and such action is consistent with the resident's plan of care." 17. The plan of care 5/22/02, addendum 6/24/02 documented the resident would be in locked seclusion only if assaultive behavior could not be controlled, addendum documented the door was kept closed but unlocked. The narrative documented the resident was maintained with the door closed and latched to keep other residents out and the resident in. 18. On 7/17/02, when asked, the Administrator stated the resident was kept in locked seclusion because the resident is combative toward staff and other residents. On 7/1702, the Unit Manager stated the resident was in locked seclusion because other residents would wander into the resident's room and that this resident would hit the intruder. 19. At 12:15 on 7/18/01 the survey team met with the Administrator, Director of Social Services, Director of Nursing and Nurse Manager of Held I. The Administrator was asked why resident #15 was locked in his her room when the alarm would let staff know he/she was coming out or that someone was going in. The surveyor stated she observed staff to respond immediately when the alarm went off at 9 am. The Administrator stated there were not always staff available to respond as they may be busy with other things. She stated again the resident attacks staff and that she observed the resident in the past to attack a housekeeper without provocation.” The mandated correction date was designated as August 17, 2002. 20. Based on the follow-up survey conducted by the Agency on August 29, 2002 and based on observation and interview, the Agency’s surveyor again found that Palm Beach County Home failed to ensure that a resident was free form involuntary seclusion and/or physical restraint. The surveyor found that the facility staff continued to keep one resident (resident #2, who was also resident #15 during the last annual recertification survey on 7/18/02) in the resident sample of 16, in locked seclusion in his/her room. The resident was kept locked in the room and could get out only when staff offered the resident time out of his/her room. The findings include the following, to wit: 21. “Resident #2 resides on the Held I unit, a closed and locked "Delayed Access Unit". On 8/29/02 the surveyor observed the resident in his/her room with the door locked/bolted from the outside with a sliding metal bolt on the bottom of the door. The door to the resident's room was observed to have a Radio Shack alarm on the top that alarmed when the door was opened (unless it was 10 disarmed by staff). The bolt lock was out of the resident's reach. The door to the room had a window cut out near the top. The window was open. The surveyor observed the resident to be locked in the room at 9:45 am and to be lying quietly on his/her bed under a green blanket at that time. At 3:45 pm the surveyor went back and again the resident was locked in the room with the door locked/bolted and the resident was sitting quietly in a chair beside the bed. 22. The surveyor asked the Licensed Practical Nurse on the unit and the Registered Nurse manager if the resident's door was locked at all times when the resident was in there, and they both stated yes. 23. The quarterly care plan review of 8/21/02 for resident #2 had the behavior problems of being physically abusive and wandering with the potential for injury to self or others. It further documented, "The door to the room is closed, the latch on the outside of the door is latched to prevent other residents from entering the room and invading the residents space and possibly getting injured." This is an uncorrected Class III deficiency from the 7/18/02 survey. 24. Based on the foregoing Palm Beach County Homes violated Sections 400.022(1) (0), and (3), Florida Statutes, ll and/or Title 42, Section 483.13(b), Code of Federal Regulation, as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as an uncorrected Class III deficiency pursuant to 400.23(8(c), Florida Statutes, which carries, in this case, an assessed fine of $1,000.00. This also gives rise to the conditional licensure status pursuant to Section 400.23(7) (b), Florida Statutes. DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statures, Palm Beach County Home shall post the license in a prominent place that is 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 “A” CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration and against Palm Beach County Home on Count I. 2. Assess an administrative fine of $1,000.00 against Palm Beach County Home on Count I for the uncorrected Class III deficiency, pursuant to Section 400.23(8) (c), Florida Statutes. 3. Assess a conditional license effective 08/29/02 against Palm Beach County Home in accordance with Section 400.23(7) (b), Florida Statutes. 4, Award the Agency costs related to the investigation and prosecution of this matter, pursuant to Section 400.121(10), Fla. Stat. 5. Grant such other relief as the 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: Kathryn F. Fenske. 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. Kathryn F. Fenske Fla. Bar No.: 0142832 Assistance General Counsel Agency for Health Care Administration Florida Bar No. 0142832 8355 N. W. 53 Street Miami, Florida 33166 305-499-2165 Fax 305-499-2195 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive West Palm Beach, Florida 33407 (U.S. Mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Skilled Nursing Home Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) EXHIBIT “A” Conditional License License No.: 14030961; Certificate No.: Effective date: 08-29-02 Expiration date: 09-30-03 9219 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Mail, Return Receipt Requested to Barbara Landy, Administrator, Palm Beach County Home 1200 45 Street, West Palm Beach, Florida 33407; Palm Beach County Health Care District, 324 Datura Street, Suite 401, West Palm Beach, Florida 33401 on this y day of Pu: , 2002. Kathryn F. Fenske

Docket for Case No: 03-000771