Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: ROSEMONT HEALTH CARE ASSOCIATES, LLC., D/B/A ROSEWOOD HEALTHCARE AND REHABILITATION CENTER
Judges: FRED L. BUCKINE
Agency: Agency for Health Care Administration
Locations: Orlando, Florida
Filed: Sep. 16, 2003
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Thursday, February 26, 2004.
Latest Update: Dec. 24, 2024
STATE OF FLORIDA Dee OS a,
AGENCY FOR HEALTH CARE ADMINISTRATION O3 SEp ; 4)
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Petitioner,
vs. Case Nos. 2003002301
2003003921
ROSEMONT HEALTH CARE ASSOCIATES, LLC.,
d.b.a. ROSEWOOD HEALTHCARE AND
REHABILITATION CENTER,
Respondent. /
ADMINISTRATIVE COMPLAINT
COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter
Agency), by and through the undersigned counsel, and files this Administrative Complaint
against ROSEMONT HEALTH CARE ASSOCIATES, LLC., d.b.a. ROSEWOOD HEALTH
AND REHABILITATION CNETR, (hereinafter Rosewood), pursuant to §$ 120.569, and
120.57, Florida Statutes, (2002), and alleges:
NATURE OF THE ACTION
This is an action to change Rosewood’s licensure status from Standard to Conditional,
commencing May 01, 2003 and ending June 5, 2003, and to impose an administrative fine in the
amount of $2,500.00 based upon one cited State Class II deficiency requiring Rosewood to
provide the necessary care and services to attain or maintain the highest practicable, mental, and
psychosocial well-being, in accordance with the comprehensive assessment and plan of care.
JURISDICTION AND VENUE
1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Fla. Stat.
2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207.
PARTIES
3. The Agency is the regulatory agency responsible for licensure of nursing homes and
enforcement of all applicable federal regulations, state statutes and rules governing skilled
nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as
amended); Chapter 400, Part II, Florida Statutes, and; Chapter 59A-4 Fla. Admin. Code,
respectively.
4. Rosewood operates a 120-bed nursing home located at 3920 Rosewood Way, Orlando,
Florida 32808, and is licensed as a skilled nursing facility, license number SNF14810962.
5. Rosewood was at all times material hereto a licensed facility under the licensing authority
of the Agency, and was required to comply with all applicable rules, and statutes.
COUNT I
6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth
herein.
7. Pursuant to Fla. Admin. Code. R. 59A-4.1288 incorporating by reference 42 CFR 483.25,
each resident must receive and the facility must provide the necessary care and services to attain
or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance
with the comprehensive assessment and plan of care.
8. On, or about, 05/01/03, the Agency conducted an annual survey of Rosewood.
9. Based on observation, interview and record review, the facility failed to ensure that one
resident of 22 sampled residents, Resident # 4, received adequate care and services in a timely
and professional manner after the resident has been identified with fecal impaction.
10. Record review of Resident # 4 revealed the resident was admitted to the facility on
6/30/97 with diagnoses of Cerebral Palsy, Quadriplegia, Mental Retardation, Urinary Tract
Infection, Constipation and history of Pneumonia. The resident was aphasic (not able to verbally
let his/her needs known) and was totally dependent on staff for activities of daily living (ADL).
The resident was bedfast, had impaired mobility and was fed via a gastrostomy tube (G-tube).
The resident has been assessed and care planned on admission as a risk for constipations and
impactions.
11. The surveyor's observation of the resident on 4/28/03, found the resident in bed, alert,
unable to communicate verbally but was able to moan and make audible sounds.
12. Review of the ADL flow sheet of the certified nursing assistant (CNA) revealed the
resident had not had a bowel movement for 12 days (1/2/03-1/14/03). The resident had been
ordered the following laxative medications: Citrate of Magnesia liquid one half bottle every
Monday and Thursday, Senokot 2 tablets 2 X a day, and Sorbitol solution 70% 30 ml.. 3 Xa day.
The resident was also ordered as needed (PRN) laxative medications: Milk of Magnesia 30 ml..
for constipation, Fleet enema solution 1 rectally as needed for constipation, Dulcolax suppository
10 mg. per rectum every 3rd day (if no bowel movement).
13. The Medication Administration Record (MAR) revealed the resident received the regular
laxative medications but did not receive any of the PRN laxative medications until the resident
vomited on 1/19/03 and had a fecal impaction.
14. Nurses' notes on 1/18/03 revealed: "the resident had a large amount of emesis at 4:10
P.M. the G-tube was in place. Digital assessment of rectum identified stool im rectum."
15. On 1/19/03 nurses' notes further revealed the resident had a fecal impaction, large yellow
emesis was observed, skin was hot to touch and temperature was 99 degrees. The resident was
medicated with Milk of Magnesia and a Fleets enema was administered as ordered PRN. There
were good results and the resident had 2 large bowel movements.
16. During the month of February the resident's ADL flow sheet revealed 4 days without
bowel movements and the PRN laxatives were not administered as ordered to prevent recurrence
of the fecal impaction.
17. A subsequent fecal impaction was noted on 2/11/03 when the resident was admitted to
the hospital for infected wound on the left buttock. Review of the ADL flow sheets revealed only
a medium bowel movement from 2/5/03 -2/11/03. A CT scan of the pelvis was performed on
2/15/03 and results revealed a "markedly distended sigmoid colon and rectum due to fecal
impaction."
18. Further review of the ADL flow sheet revealed the facility staff continued to chart bowel
movement when the resident in fact was in the hospital from 2/11/03 -2/24/03 and not in the
facility.
19. Interview with facility staff on 4/29/03 confirmed that PRN laxatives were not
administered during the 2 incidents of fecal impactions since the resident was on regular laxative
medications already.
20. The nurse failed to monitor whether regular medications were effective and did not
administer any PRN laxative medication to prevent fecal impaction. Facility staff was also asked
at the same time to provide the policy and procedure for problems of constipation but was unable
to produce one.
21. The Agency determined that Rosewood's deficient practices in this instance, affected one
resident and compromised the resident's ability to maintain or reach his/her highest practical
physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive
resident assessment, plan of care and provision of services and, pursuant to § 400.23(8)(b), cited
Rosewood's deficient practice as a State Class II deficiency.
WHEREFORE, the Agency intends to impose an administrative fine in the amount of
$2,500.00 against Rosewood, a skilled nursing facility in the State of Florida, pursuant to §§
400.23(8) and 400.102, Fla. Stat., and assess costs related to the investigation and prosecution of
this case, pursuant to § 400.121(10), Fla. Stat.
COUNT II
22. The Agency re-alleges and incorporates paragraphs (1) through (5) and (7) through (21)
as if fully set forth
23. Based upon one cited State Class II deficiency, Rosewood was not in substantial
compliance at the time of the survey with criteria established under Part II of Florida Statute 400
or the rules adopted by the Agency, a violation subject to assignment of a conditional licensure
status under § 400.23(7)(b), Fla. Stat.
WHEREFORE, the Agency intends to assign a conditional licensure status to Rosewood,
a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(7), for the period
commencing May 01, 2003 and ending June 5, 2003.
Respectfully submitted this & TA __ day of August 2003.
baal Uy Ly)
Gerald L. Pickett
Fla. Bar. No. 559334
Counsel for Petitioner
Agency for Health Care
Administration
525 Mirror Lake Drive, 330K
St. Petersburg, FL 33701
727.552.1526 (office)
727.552.1440 (fax)
DISPLAY OF LICENSE
Pursuant to § 400.23(7)(e), Fla. Stat., Rosewood shall post the current 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.
Respondent is notified that it has a right to request an administrative hearing pursuant to Section
120.569, Florida Statutes. Specific options for administrative action are set out in the attached
Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All
requests for hearing shall be made to the Agency for Health Care Administration, and delivered
to: Lealand McCharen, Agency Clerk, Agency for Health Care Administration, 2727 Mahan
Drive, MS #3, Tallahassee, Florida, 32308, (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.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by
U.S. Mail Certified, Return Receipt No: 7002 2030 0007 8499 7222, on August LL _, 2003 to:
Administrator, Rosewood Health and Rehabilitation, 3920 Rosewood Way, Orlando, Florida
32808 and U.S. Mail to C T Corporation System, Registered Agent for Rosemont Health Care
Associates, LLC, 1200 South Pine Island Road, Plantation, Florida 33324.
Copies furnished to:
Administrator CT Corporation System Gerald L. Pickett
Rosewood Health and Registered Agent for Agency for Health Care
Rehabilitation Center Rosemont Health Care Administration
3920 Rosewood Way Associates, LLC 525 Mirror Lake Drive, 330K.
Orlando, Florida 32808 1200 South Pine Island Road St. Petersburg, FL 33701
(U.S. Certified Mail) Plantation, Florida 33324
(U.S. Mail)
Docket for Case No: 03-003327
Issue Date |
Proceedings |
Feb. 26, 2004 |
Joint Motion to Relinquish Jurisdiction (filed by Petitioner via facsimile).
|
Feb. 26, 2004 |
Order Closing File. CASE CLOSED.
|
Feb. 25, 2004 |
Final Order filed.
|
Jan. 30, 2004 |
Order of Pre-hearing Instructions.
|
Jan. 30, 2004 |
Notice of Hearing (hearing set for March 3, 2004; 9:00 a.m.; Orlando, FL).
|
Jan. 29, 2004 |
Status Report (filed by Respondent via facsimile).
|
Dec. 30, 2003 |
Order Granting Continuance (parties to advise status by January 30, 2004).
|
Dec. 30, 2003 |
Status Report (filed by Respondent via facsimile).
|
Dec. 11, 2003 |
Order Granting Continuance (parties to advise status by December 31, 2003).
|
Dec. 11, 2003 |
Joint Motion for Continuance (filed via facsimile).
|
Dec. 02, 2003 |
Order. (R. Davis Thomas, Jr., is authorized to appear in this administrative proceeding as the Qualified Representative of the Respondent).
|
Dec. 02, 2003 |
Joint Pre-hearing Stipulation (filed via facsimile).
|
Dec. 01, 2003 |
Motion to Allow R. Davis Thomas, Jr., to Appear as Respondent`s Qualified Representative (filed via facsimile).
|
Dec. 01, 2003 |
Notice for Deposition Duces Tecum of Agency Representative (filed via facsimile).
|
Oct. 28, 2003 |
Order Granting Continuance and Re-scheduling Hearing (hearing set for December 12, 2003; 9:30 a.m.; Orlando, FL).
|
Oct. 24, 2003 |
Motion for Continuance of the Final Hearing (filed by Petitioner via facsimile).
|
Oct. 07, 2003 |
Order of Pre-hearing Instructions.
|
Oct. 07, 2003 |
Notice of Hearing (hearing set for November 14, 2003; 9:30 a.m.; Orlando, FL).
|
Sep. 30, 2003 |
Joint Response to Initial Order (filed by D. Stinson via facsimile).
|
Sep. 18, 2003 |
Initial Order.
|
Sep. 16, 2003 |
Standard License filed.
|
Sep. 16, 2003 |
Conditional License filed.
|
Sep. 16, 2003 |
Administrative Complaint filed.
|
Sep. 16, 2003 |
Request for Formal Administrative Hearing filed.
|
Sep. 16, 2003 |
Notice (of Agency referral) filed.
|