STATE OF FLORIDA 03 MAY 28 PH 2:3] AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINS Rai dve ADMINISTRATION, HEA IRGS Petitioner, AHCA No.: 2002049128 AHCA No.: 2003002327 Vv. Return Receipt Requested: 7002 2410 0001 4236 7836 GARDENS COURT MEDICAL INVESTORS, 7002 2410 0001 4236 7843 LLC., @/b/a GARDENS COURT, 7002 2410 0001 4236 7850 Respondent. O ?>- DOOY / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA” or the “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against Gardens Court Medical Investors, LLC, d/b/a Gardens Court (hereinafter “Gardens Court” or the “facility”), pursuant to Chapter 400, Part II, Florida Statutes (2002) (hereinafter ‘Fla. Stat.”) and Chapter 59A-4, Florida Administrative Code (hereinafter “Fla. Admin. Code”) and alleges: NATURE OF THE ACTION 1. This is an action to impose and maintain the Agency’s administrative fine of $5,000 pursuant to §400.23(8), Fla. Stat. (2002), and an action to maintain the Agency’s assignment of a Conditional Licensure Status to Gardens Court, pursuant to §400.23(7), Fla. Stat. (2002), for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Chapter 400, Part II, Fla. Stat., (2002). 3. Venue lies in Palm Beach County, pursuant to §400.121 (1) {(e), Fla. Stat. And Rule 28.106.207, Fla. Admin. Code. PARTIES 4. 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. (2002), and Chapter 59A-4 Fla. Admin. Code. 5. Gardens Court operates a 120-bed skilled nursing facility located at 3803 PGA Boulevard, Palm Beach Gardens, Florida 33410. Gardens Court is licensed as a skilled nursing facility, license number SNF16460962; certificate number 10065, effective 3/19/2003 through 4/30/2003. Gardens Court 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 GARDENS COURT FAILED TO PROVIDE THE NECESSARY CARE AND SERVICES TO PREVENT FALLS FOR ONE OF 2 SAMPLED RESIDENTS TITLE 42 §483.25, CODE OF FEDERAL REGULATIONS INCORPORATED BY RULE 59A-4.1288, FLA. ADMIN. CODE (QUALITY OF CARE) CLASS II DEFICIENCY 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Because Gardens Court participates in Title XVIII or XIX it must follow certification rules and regulations found in 42 Code of Federal Regulation 483. 8. During the complaint investigation conducted on 3/19/03 and based on observation, interviews, and record reviews the facility failed to provide the necessary care and services to prevent falls for 1 of 2 sampled residents (Resident #1). 9. Resident #1 was admitted to the facility on December 31, 2002, status post a fall with a closed fracture to the right hip. Record review revealed that the resident had numerous diagnoses of which included End Stage Renal Disease with dialysis 3X's weekly, Functional decline, Atrial Fibrillation, Ischemic Heart Disease, and an AV fistula in the right upper arm. 10. On admission the MDS dated 1-06-03 on section G b- transfer, the resident is coded as 3/3. 3=Extensive Assistance 3=2+person physical assist. 11. On 1-10-03 and 1-24-03 the MDS on section G b- transfer, the resident is coded as 3/2. 3=Extensive Assistance 2=one person physical assist. On all of the MDS the cognitive status is coded 0, no short term or long term memory impairment. 12. Record review revealed that on the evening of February 17, 2003 at 7:15 P.M. the resident had been up in a wheel chair for approximately 3 hours. The nursing assistant came into the room to put the resident back to bed. She proceeded to go around the chair behind the resident and let the resident make the transfer alone without assistance. The resident stood up lost his/her balance and fell forward, hit his/her face on the roommate's bed rail and sustained a cut to the lip. The resident also hit his/her arm on the wheelchair during the fall. The resident complained of extreme pain, the nurse was called and came into the room to find the resident on the floor, where she left him/her not knowing the extent of the injuries. EMS was called and responded. The resident was transported to Palm Beach Gardens Medical Center emergency room complaining of terrible pain in his arms/shoulder. It was determined after x-rays that the patient had a fractured humerus. A sling was applied and the patient was sent back to the facility at 11P.M., with instructions to follow up with an orthopedic doctor, apply ice, and a prescription for pain medication. 13. Interview with the resident's spouse at 8:00A.M. on 3-19-03 revealed that she was just coming into the room when she saw the resident falling to the floor and the nursing assistant standing behind the wheelchair, unable to assist the resident. "She should have helped him, what good was it for her to stand behind the chair?" She further stated that the aide never touched the resident at all, and she had to put a pillow under her husband's head. The nurse came into the room and called the paramedics. 14. Interview with the Administrator, and the Risk Manager at 10:45A.M.on 3-19-03 revealed that the nursing assistant did attempt to transfer the resident from the wheelchair to the bed, but stood behind the chair and when the resident started to fall she wasn't able to support or hold on to the resident at that point. The CNA was suspended for three days, and upon returning to work, she was instructed by therapy on safe transfer techniques. 15. Interview with the resident at 2:30 P.M. on 3-19-03 revealed that on 2-17-03 the nursing assistant came into the room at 7:15 P.M. to get him/her back to bed. " She stood behind the chair and let me get up by myself." This surveyor asked if the aide told him to wait so she could assist him/her with the transfer? He/she replied "no". When I stood up there was nothing to hold onto, and I lost my balance and fell forward. I hit my arm on the wheel chair, and my lip on my roommate's bed rail." 16. Interview with the CNA was conducted at 3:00P.M. in the presence of the Director of Nursing. The interview was confusing at times, in that the CNA did not have a good command of the English language. (a) I asked her to tell this surveyor what happened on the night of February 17, 2003 when the resident fell. (b) After several attempts to understand where she was standing and where the resident fell, the DON recommended she draw a diagram of the room showing the beds, and the space where the resident was before she attempted to get the resident back to bed. She did state that she stood behind the resident and assisted him/her to stand by pushing up under the armpits. She then stated that after the resident was ina standing position he/she tried to fix their brief because it was coming loose. It was at that point that the resident lost their balance and fell forward hitting his/her arm on the chair and their face on the roommate's bedrail, and cutting his/her lip. At this point the spouse came into the room. 17. The resident remained at the facility for approximately one month. Occupational and Physical Therapy provided services, for both the hip and shoulder fracture. On March 17, 2003, the resident was seen by the Nurse Practitioner, and a chest x-ray was ordered at 9:30A.M. The resident had a productive cough and had blood tinged sputum. The result of the chest x-ray revealed the resident had Left Lower Lobe Pneumonia. The physician was called and gave an order to send the resident to the hospital. The resident was still at the hospital at the time of this investigation. 18. The facility did not provide the necessary care and services to prevent this resident's fall/injury. 19. Based on the foregoing, Gardens Court violated $483.25 Code of Federal Regulations, as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as a Class II deficiency pursuant to §400.23(8) (b), Fla. Stat., which carries, in this case, a fine of $5,000 and gives rise to a conditional rating pursuant to §400.23(7), Fla. Stat. DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes Gardens Court 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 against Gardens Court on Count I. 2. Assess against Gardens Court an administrative fine of $5,000 on Count I for the Class II violation pursuant to 400.23(8) (b), Fla. Stat. 3. Uphold the conditional rating on the license of Gardens Court pursuant to §400.23(7). 4, Assess costs related to the investigation and prosecution of this matter, if applicable 5. Grant such other relief as the court deems is just and proper on Count I. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). 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, Agency Clerk, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308. Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR 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. Assistant General Counsef Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive, Suite 100 West Palm Beach, FL 33407 (Interoffice mail) Jean Lombardi 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, Mail Stop #33 Tallahassee, Florida 32308 (Interoffice Mail) 10 EXHIBIT “A” Conditional License License # SNF 16460962; Certificate No.: Effective date: 03/19/2003 Expiration date: 04/30/2003 ll 10065 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Patricia Allard, CNHA, Gardens Court, 3803 PGA Boulevard, Palm Beach Gardens, Florida 33410, Gardens Court Medical Investors, LLC, 3570 Keith Street, NW, Cleveland, TN 37312, and to CT Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324, on this | day of oO , 2003. Nelson E. Rodney 12

Docket for Case No: 03-002006