STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION A 29 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2003002412 AHCA No.: 2003002050 Vv. Return Receipt Requested: 70002 2410 0001 4237 3370 DELTA HEALTH GROUP, INC. d/b/a 70002 2410 0001 4237 3387 SALERNO BAY MANOR, 70002 2410 0001 4237 3394 Respondent. O ey DO (Q- 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 Delta Health Group, Inc. d/b/a Salerno Bay Manor (hereinafter “Salerno Bay Manor”) pursuant to 28-106.111, Florida Administrative Code and Chapter 120, Florida Statutes, and alleges: NATURE OF THE ACTIONS 1. This is an action to impose and maintain the Agency’s administrative fine against Salerno Bay Manor in the amount of $2,000.00, pursuant to Sections 400.102, 400.121, 400.23, Florida Statutes [AHCA No.: 2003002050]. 2. This is an action to impose and maintain the Agency’s assignment of a conditional licensure rating to Salerno Bay Manor, pursuant to Section 400.23(7) (b), Florida Statutes [AHCA No. 2003002412]. JURISDICTION AND VENUE 3. This court has jurisdiction pursuant to Section 120.569 and 120.57, Florida Statutes and Chapter 28-106, Florida Administrative Code. 4. Venue lies in Martin County, pursuant to Section 120.57 and Section 121(1)(e), Florida Statutes and Chapter 28- 106.207, Florida Administrative Code. PARTIES 5. AHCA is the enforcing authority with regard to nursing home licensure pursuant to Chapter 400, Part II, Florida Statutes and Rule 59A~-4, Florida Administrative Code. 6. Salerno Bay Manor is a skilled nursing facility located at 4801 S. E. Cove Road, Stuart, Florida 34997 and is licensed under Chapter 400, Part II, Florida Statutes and Chapter 59A-4, Florida Administrative Code. COUNT I SALERNO BAY MANOR FAILED TO FOLLOW PHYSICIANS’ ORDERS AS PRESCRIBED, AND/OR FAILED TO ENSURE THAT SERVICES PROVIDED MET PROFESSIONAL STANDARDS OF QUALITY. RULE 59A-4.107 (5), FLORIDA ADMINISTRATIVE CODE, And/or TITLE 42 SECTION 483.20(k) (3) (i), CODE OF FEDERAL REGULATIONS, RULE 59A-4.1288, FLORIDA ADMINISTRATIVE CODE (RESIDENT ASSESSMENT) UNCORRECTED CLASS III DEFICIENCY 7. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 8. Because Salerno Bay Manor participates in Title XVIII or XIX, it must follow the certification rules and regulations found in Title 42 Code of Federal Regulation 483, as incorporated by Rule 59A-4.1288, F.A.C. 9, During the standard survey conducted by the Agency on January 15, 2003 and based on record review and interview, the Agency found that Salerno Bay Manor failed to follow physicians’ orders as prescribed, and/or failed to ensure that services provided met professional standards of quality. The Agency determined that the facility failed to provide services that meet professional standards of quality for two residents out of twenty one sampled residents and out of 19 additional randomly selected residents, as physician orders were not followed and/or clarified for one resident (resident #2), and physician orders were not specific/clear for another resident (resident #8). The findings include the following, to wit: 10. During the review of the clinical record of resident #2 on 01/13/03, it was noted the resident had a readmission date of 09/12/02. The diagnoses were Renal Failure, Fractured Clavicle, CHF, Diabetes, Pulmonary Edema. Depression, Clotted Graft, and PVD. It was also noted that the resident receives dialysis services from an outside service 3 times per week and is out of the facility from approximately 10 AM to 4 PM. A review of the physicians orders, dated January 1, 2003, revealed that the resident was to have the medication Renagel administered 3 times per day with meals and blood sugar Accu- Checks before each meal and every evening. A review of the January 2003 MAR of resident #2 revealed that the noon dose of Renagel and 11:30 Acu-Check were not being administered while the resident was out at the facility at the dialysis center. An interview conducted with the charge nurse revealed that the Renagel was not being administered and Accu-Check were not being done by the dialysis center. The nurse further stated that the attending physician and dialysis physician were not notified for clarification of the orders and that the current orders were not being followed correctly. 11. Resident #8 had a doctor's order on the January physicians orders for Xaltan .005% eye drops at bedtime, the order did not specify which eye the drops were to be put in. 12. The mandated correction date was designated as February 15, 2003. 13. During a follow-up visit to the standard survey, conducted on February 26, 2003, and based on record review and interview on February 26,2003, the Agency again found that Salerno Bay Manor failed to follow physicians’ orders as prescribed, and/or failed to ensure that services provided met professional standards of quality. The Agency found that the nurses did not transcribe physicians’ orders correctly, administer all medications correctly and ensure that physicians’ orders were followed. This finding is for one resident in a sample of thirteen residents (resident #3). Findings include the following, to wit: 14. On February 26, 2003, at 12 noon, the surveyor reviewed the physician’s orders for medication for resident #3; the surveyor then reviewed the medication administration record. On admission February 17,2003 resident #3 had physicians orders for one Enteric Aspirin 325 mg. by mouth daily and Heparin 5000 units twice a day. Both medications have anticoagulants effects, residents on these drugs can bleed more if bruised or cut. The orders transcribed by the an nurse had no route of administration for the Heparin. The medication administration record documented the order for Heparin as 5000 units BID (twice a day) subcutaneously (by injection); the time for administration was 5 pm daily. From 2/18/03 to 2/25/03 the nurses had documented they gave only one dose of Heparin daily. The nurse manager was shown the order and the medication record at 12:15 pm she stated the Heparin administration was an error and that she would call the doctor and make out a medication variance report. 15. Based on the foregoing, Salerno Bay Manor violated 59A-4.107(5), F.A.C., and/or 483.20 (k) (3) (i), Code of Federal Regulation, as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as an uncorrected Class III deficiency pursuant to Section 400.23(8), Florida Statutes, which carries an assessed fine of $1,000.00. This also gives rise to a conditional licensure status, pursuant to Section 400.23(7) (b), Florida Statutes. COUNT ITI SALERNO BAY MANOR FAILED TO ADEQUATELY REPORT RESIDENTS’ INJURIES OF UNKNOWN SOURCE. RULE 59A-4.106(2), FLORIDA ADMINISTRATIVE CODE, And/or SECTION 400.147(1) (d), FLORIDA STATUTES, And/or SECTION 400.022 (1)((1), and (3),FLORIDA STATUTES, And/or 483.13(c) (2),(3),(4), CODE OF FEDERAL REGULATION, as incorporated by RULE 59A-4.1288, FLORIDA ADMINISTRATIVE CODE (STAFF TREATMENT OF RESIDENTS) UNCORRECTED CLASS III DEFICIENCY 16. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 17. During the standard survey conducted by the Agency on January 13, 2003 through January 15, 2003, and based on interview with the Director of Social Service and interview with the West Wing Nurse Manager and the Risk Manager, the Agency found that Salerno Bay Manor failed to adequately report residents’ injuries of unknown source. The Agency found that all injuries of unknown source/occurrences of potential neglect were not being reported and investigated. During a review of eleven grievance reports on one of eleven the report documented that a resident, Random resident #24, was transported with a wet paper towel on a wound, and not a dressing. This was not reported or investigated as neglect. The findings include the following, to wit: 18. Review of grievances on 1/14/03 revealed documentation of a grievance from a staff member dated 9/9/02. This documented a resident had been transported with a damp paper towel on a wound on the left heel and no dressing. On 8/29/02 a physician order indicated that starting on 8/29/02 this left heel was to be cleansed, ointment applied and dressed with gauze and Hypafix. The Grievance Investigation Report documented in the recommendation and corrective action section " wound covered left heel, nurses in-serviced all wound care." On 1/14/03, the Social Service Director stated the Risk Manager would know if any neglect investigation had been conducted involving this grievance. The Risk Manager who was the abuse neglect coordinator stated on 1/14/03 she knew nothing about this occurrence/grievance and to speak to the West Wing Nurse Manager who had signed the Grievance Investigation Report. The Nurse Manager of the west wing was interviewed at 6:15 pm on 1/14/03 she stated this occurrence/grievance was not investigated as neglect because she did not see this grievance as an issue of neglect. There was no evidence that a report was ever made by the facility to the State (Agency for Health Care Administration). 19. The mandated correction date was designated as February 15, 2003. 20. During the revisit to the standard survey conducted on February 26, 2003 and based on review of the clinical record and interview, the Agency again found that Salerno Bay Manor failed to adequately report residents’ injuries of unknown source. The Agency found that for one resident, ina sample of thirteen, the facility did not report the occurrence of a fractured arm (a fracture of unknown origin) to the Adult Protective Services Florida Abuse Hotline, at 1-800-96-ABUSE (Adult Protective Services) immediately when the fracture was found as required by the facility Operational Policy and Procedure. The fracture was found on 1/31/03 or 2/1/03 (the documentation in the record listed both dates) Adult Protective Services was notified on 2/17/02, seventeen days later. The findings include the following, to wit: 21. During record review for resident #7 the surveyor read a nurses note dated February 1, 2003 (Saturday) at 3 pm which read "Resident observed with bruising and edema to left upper arm" complaining of pain at site of bruising. Doctor called orders for resident to be sent to hospital for evaluation." A second nurses note the same day, time 9:45 pm " Resident returned from (hospital) with diagnosis of fractured to left upper humerus new orders noted in tar no complaints of pain or distress at this time. Call bell within reach will continue to (illegible)." 22. The exception report on the record documented the occurrence date was Friday 1/31/03 at 6:30 pm and documented "upon doing rounds after resident returned from dialysis I observed bruising on residents left upper arm and swelling complaining of pain at site of bruising." 23. The facility policy "Prevention of Resident Abuse, Neglect, Mistreatment or Misappropriation of Property" Operational Policies and Procedure 1/6/03 page 49 of 102 documents, "Upon suspecting abuse, neglect, immediately notify Florida Abuse Hotline 1-800-96-ABUSE." 24. Interview with the facility Abuse Neglect Coordinator on 2/26/03 between 2 and 3 pm revealed the facility investigation did not conclude how the fractured arm occurred, she did state her investigation concluded the fracture did not occur at the facility. The nurses’ note in the clinical record made by the Abuse Neglect Coordinator had the date 2/17/02, which was an incorrect date the correct date she stated was 2/17/03. Interview with her on 2/26/03 confirmed that she stated the fracture was not reported to Adult Protective Services until February 17,2003. This is an uncorrected deficiency from the survey of January 15, 2003. 25. Based on the foregoing, Salerno Bay Manor violated Rule 59A-4.106(2), Florida Administrative Code, and/or Section 400.147(1) (d), Florida Statutes and/or Section 400.022(1) (1), and (3), Florida Statutes, and/or 483.13(c) (2), (3), (4), Code of Federal Regulation, as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as an uncorrected Class Til deficiency pursuant to Section 400.23(8), Florida Statutes, which carries an assessed fine of $1,000. This also gives rise to a conditional licensure status, pursuant to Section 400.23(7) (b), Florida Statute. DISPLAY OF LICENSE Pursuant to Section 400.25(7), Florida Statutes Salerno Bay Manor 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” EXHIBIT “A” Conditional License License # SNF 14880961; Certificate No.: Effective date: 02-26-2003 Expiration date: 12-31-2003 10002 PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: 1. Make factual and legal findings in favor of the Agency on Counts I and II. 2. Assess and maintain the Agency’s administrative fine of $2,000.00 against Salerno Bay Manor, for the two (2) Class III violations cited in Counts I and II. 3. Assess and maintain the Agency’s assignment of a conditional license against Salerno Bay Manor, in accordance with Section 400.23(7), Florida Statutes. 4. Assess costs related to the investigation and prosecution of this matter, pursuant to Section 400.121(10), Fla. Stat. 5, 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 (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 Clerk, 13 Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE A REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, Kathryn F. Fenske, Esq. Assistance General Counsel Agency for Health Care Administration Fla. Bar No. 0142832 8355 N. W. 53 Street Miami, Florida 33166 305-499-2165 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration i710 E. Tiffany Drive ~- Suite 100 West Palm Beach, Florida 33407 Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 14 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 Derek Hunt Buckley, Administrator, Salerno Bay Manor, 4801 S. E. Cove Road, Stuart, Florida 34997; Delta Health Group, Inc., 2 N. Palafox Street, Pensacola, Florida 32501; Sondra McCrory, 2 North Palafox Street, Pensacola, Florida 32501 on this xe day of t—— Kathryn F. Fenske, Esq. , 2003.

Docket for Case No: 03-002012