STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 03 AUG 25 Pif 3:45 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Vv. KINDRED NURSING CENTERS EAST, LLC. d/b/a REHABILITATION CENTER OF THE PALM BEACHES, Respondent. AHCA No.: 2003004464 2003003792 Return Receipt Requested: 7002 2410 0001 4236 8529 7002 2410 0001 4236 8536 7002 2410 0001 4236 8543 ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Kindred Nursing Centers East, LLC. d/b/a Rehabilitation Center of the Palm Beaches ‘hereinafter “Rehab Center of the Palm Beaches”), pursuant to Chapter 400, Part II, and Section 120.60, “lorida Statutes (2002) (hereinafter “Fla. Stat.”), 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), Fla. Stat., for the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Rehab Center of the Palm Beaches, 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.C. 4. Venue lies in Palm Beach 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 59R-4 Florida Administrative Code. 6. Rehab Center of the Palm Beaches operates a 99- bed skilled nursing facility located at 301 Northpointe Parkway, West Palm Beach, Florida 33407. Rehab Center of the Palm Beaches is licensed as a skilled nursing facility; License number SNF1470096; certificate number 10281, effective 05/12/2003 through 04/30/2004. Rehab Center of the Palm Beaches 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 REHAB CENTER OF THE PALM BEACHES FAILED TO MAINTAIN ALL CLINICAL RECORDS COMPLETE AND ACCURATELY DOCUMENTED Title 42, Section 483.75(1) (1), Code of Federal Regulations And Rule 59A-4.1288, Florida Administrative Code (ADMINISTRATION) UNCORRECTED CLASS III DEFICIENCY 7. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 8. Because Rehab Center of the Palm _ Beaches 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 the standard survey conducted 4/08-10/03 Based on observation, interview and record review, it was determined that the facility failed to maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete and accurately documented, for residents #'s 3, 2, 9, 8, and 12. The findings include: {a) Upon review of the medical record for Resident #3, on 04/08/03, at 11:00 A.M., the social service note dated 02/11/03 documented the resident was receiving Restoril 7.5 milligrams at bedtime. Further review of the we resident’s medical record revealed no current or past Doctor's order written for the drug Restoril. An interview was conducted at 11:20 A.M. with the medication nurse on the residents unit. She stated that the resident was not on Restoril and she did not remember the resident ever being on Restoril. (b) An interview was conducted at 11:30 A.M. with the social worker who had written the note, and it was stated, "T will have to look in the resident's old chart". After checking the old and new medical record of Resident #3 the social worker admitted he/she was writing about another resident. (c) Observation of resident #3 was conducted 04/08/03, at 1:15 P.M. The resident was wearing an incontinent pad under a clean hospital gown and a dressing on the left foot. (d) Upon record review at 1:30 P.M., the 2/18/03 Minimum Data Set (MDS) for Resident #3 recorded the resident was continent of bowel and bladder. (e) An interview was conducted with the unit manager (a registered nurse) of the resident's unit. She stated the resident had been incontinent of bowel and bladder since admission 11/06/02. (f) Resident #9'S Medication Administration Record (MAR) was reviewed at 1:45 PM on 04/08/03 (both the front and the backside of the document). The review revealed the facility had not documented that the resident's Glyburide was given at 7:00 AM that morning (04/08/03). The 7:00 AM medication block was blank on the MAR. The surveyor discussed the above finding with the floor nurse on the unit where the resident resided. She told the surveyor that the nurse probably gave the resident the medication but did not record it on the MAR. When the surveyor requested that he interview the nurse who gave the medication the floor nurse said she was not available (had gone home). If the medication was not given there was no documentation to indicate why it was not given as ordered. (g) During review of the clinical record of Resident #12 on 4/9/03, it was revealed that the Treatment 2ecords and the Medication Administration Records were incomplete. (h) A review of the Medical Administration record for Percocet to be administered every 12 hours during the month of March had five unsigned spaces, and a review of the Treatment Record with orders for Heel Protectors to be worn at all times had 11 unsigned spaces for the month of 3/ 03, 19 unsigned spaces for 2/03 and 10 wW unsigned spaces for 1/03. Based on the above documentation the record was determined to be incomplete. There was no documentation of an explanation for these unsigned areas. (1) During review of Resident #2's medical record on 4/9/03, it was revealed that the Medical Administration Record (MAR) was incomplete. The MAR had blank spaces where initials should be marked indicating the task had been completed for April 1-10, 2003. These areas included the documentation for the Enteral Feeding Product/ cevity Plus to run at 65cc/HR via feeding tube had 6 blank spaces, and the record for Auscultate Substernal region every 4 hours had 3 blank spaces. An order to Aspirate Gastric contents every 4 hours had 2 blank spaces. During the month of March, there were 3 blank spaces for Flush G- Tube, 3 blank spaces, for Auscultate Substernal region every 4 hours, and 1 unsigned space on order to Aspirate Gastric contents every 4 hours. There was no documentation of an explanation for these unsigned blank spaces. (Jj) Resident #8 was admitted to the facility on 12-24-94 with diagnoses that included Fractured Tibia, Hypertension, Congestive Heart Failure, Cellulitis and documented with 2 Stage II Pressure Sores (per the Minimum Data Set dated 1-24-03). (k) Review of the Medication Administration Record (MAR), done on 4-10-03, revealed incomplete documentation for various ordered medications on various dates. The omissions on the MAR include: (1) Vitamin Cc 500 mg was ordered to be given by mouth two times daily and on 4-2-03 at 5:00 PM there was a blank space left on the MAR for this administration time. (2) Atenolol 25 mg was ordered to be given by mouth two times daily and on 4-2-03 at 5:00 PM. there was a blank space left on the MAR for this administration time. (3) Endocet 5/325mg was ordered to be given by mouth every six hours as needed for leg pain and was given at 10:00 PM on 4-8-03 but was not signed on the front sheet of the MAR, but signed on the back to indicate reason given and results. (1) Review of the Treatment Administration Record (TAR), done on 4-10-03, revealed incomplete documentation for various ordered treatments on various dates. The omissions on the TAR include: (1) "Heel protectors on at all times when in bed. Monitor every shift." Omissions were noted for 4- 1-03, 4-3-03, 4-5-03, 4-6-03, and 4-7-03 on various shifts. (2) "Float heels with pillows beneath calves when in bed for pressure reduction." Omissions were noted on 4-3-03, 4-5-06, 4-6-03, and 4-9-03 on various shifts. (3) "RElevate heels when in bed." Omissions were noted on 4-3-03 and 4-5-03 for the 7:00 AM to 7 PM shift. (4) "Foley care every shift as per protocol." Omissions were noted on 4-2-03, 4-3-03, 4-5-06, 4-6-03, and 4-9-03 on various shifts. (m) Documentation was not indicated on the backs cf the MARs or TAR, as required, to document why the medications or treatments were not given as_ ordered. Correction date: May 10, 2003 10. Based on record reviews and interviews conducted during the 5/12/03 revisit, it was determined the facility failed tc maintain records that are complete and accurately documented for 2 of 10 sampled residents (resident #7 and resident #9). The findings are: (a) Review of the record revealed resident #7 was admitted to the facility on 5/4/03 with a diagnosis of status post left hip fracture, fractured arm and Alzheimer disease. (b) Review of the 5/5/03 fall risk assessment revealed the resident was assessed as a moderate risk for falls. The resident's risk was scored as 9. The assessment section titled Significant history had not been completed. If the significant history section had completed, the fall assessment would have identified the resident at a high risk for falls based on a history of falls within 6 months. The fall risk assessment would have been scored a 17, which would have correctly identified the resident at a high risk for falls. (c) Resident #9 is receiving an antipsychotic medication which requires daily per shift documentation of behaviors and monitoring for the significant side effects of the medication on the behavior monitoring record, according to the Director of Nursing and the Assistant Director of Nursing interviewed at 1:45 P.M. Further interview revealed if there are no behaviors, the nurse will write zero (0). (a) Review of the behavior monitoring record revealed the nurse on 5/12/03 7AM -7PM shift had filled in the daily monitoring for the 7AM - 7 PM shift prior to completion of the shift. A copy of the record was received by 1:40 PM on 5/12/03. In addition, the record lacked documentation of behavior monitoring on May 2 and May 3 for the 7PM- 7 AM shift. This area on the record was observed to be blank. This is an uncorrected deficiency from the survey of 4/08-10/03. 11. Based on the foregoing, Rehab Center of the Palm Beaches violated Title 42, Section 483.75(I) (1), Code of Federal Regulations, as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as an uncorrected Class III deficiency pursuant to Section 400.23(8) (c), Fla. Stat., which carries, in this case, an assessed fine of $1,000.00. 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, Rehab Center of the Palm Beaches shall post the license in a prominent place that is in clear and unobstructed public wiew at or near the place where residents are being admitted to the facility. The Conditional License is attached hereto as Exhibit wan 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 $1,000.00 against Rehab Center of the Palm Beaches, pursuant to Section 400.23(8) (c), Fla. Stat. Cc. Assess and assign a conditional license status to Rehab Center of the Palm Beaches, 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 opticns 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 deliverec to the Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida 32308, attention Lealand McCharen, Agency Clerk, Telephone (850) 922-5873. 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. 7 Nelso . Rodney 2 Assistant General Counsel Agency for Health Care Administration Florida Bar No. 178081 8355 N. W. 53 Street Miami, Florida 33166 (305) 499-2165 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive, Suite 100 West Palm Beach, Florida 33407 (U.S. 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)

Docket for Case No: 03-003090