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