STATE OF FLORIDA DF px, AGENCY FOR HEALTH CARE ADMINISTRATION “* ~2 p,, 4; of They AGENCY FOR HEALTH CARE i ADMINISTRATION, . Petitioner, AHCA No.: 2003006660 AHCA No.: 2003006657 Vv. Return Receipt Requested: 7002 2410 0001 4236 9236 STUART OPERATING CORP., d/b/a 7002 2410 0001 4236 9243 STUART NURSING & RESTORATIVE CARE CENTER, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter referred to as “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Stuart Operating Corp., d/b/a Stuart Nursing & Restorative Care Center (hereinafter “Stuart Nursing & Restorative Care Center”), pursuant to Chapter 400, Part II, and Section 120.60, Fla. Stat. (2002), and alleges: NATURE OF THE ACTIONS i. This is an action to impose an administrative fine of $2,500.00 pursuant to Section 400.23(8), Fla. Stat. (2002), for the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Stuart Nursing & Restorative Care Center, pursuant to Section 400.23(7) (b), Fla. Stat (2002). JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2002), and Chapter 28-106, F.A.C. 4. Venue lies in Martin County, pursuant to Section 400.121(1)(e), Fla. Stat. (2002), 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., (2002), and Chapter 59A-4 Florida Administrative Code. 6. Stuart Nursing & Restorative Care Center is a 120-bed skilled nursing facility located at 1500 Palm Beach Road, Stuart, Florida 34994. Stuart Nursing & Restorative Care Center is licensed as a skilled nursing facility; license number SNF15260962; certificate number 10564, effective 07/29/2003, through 12/31/2003. Stuart Nursing & Restorative Care Center 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. 7. Because Stuart Nursing & Restorative Care Center participates in Title XVIII or XIX, it must follow the certification rules and regulations found in Title 42 C.F.R. 483, as incorporated by Rule 59A-4.1288, F.A.C. COUNT I STUART NURSING & RESTORATIVE CARE CENTER FAILED TO ENSURE THAT EACH RESIDENT RECEIVES ADEQUATE SUPERVISION AND ASSISTANCE DEVICES TO PREVENT ACCIDENTS TITLE 42, SECTION 483.25(h) (2) CODE OF FEDERAL REGULATIONS, INCORPORATED BY RULE 59A-4.1288, FLORIDA ADMINISTRATIVE CODE (QUALITY OF CARE) CLASS II DEFICIENCY 8. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 9. During a complaint investigation conducted on 7/29/2003 and based on record review, interview and observation conducted during the 7/29/03 complaint investigation, it was determined the facility failed to ensure 1 of 5 sampled residents (resident #4) received adequate supervision and assistance to prevent an accident. The findings were: a) Sampled resident #4 has a diagnosis of dementia, aggressive behavior, Rheumatoid Arthritis as well as various other chronic diseases. The resident was assessed as follows in comprehensive assessments dated 4/14 and 7/14/03: short and long term memory problems, severe cognitive impairment for decision making, altered mood and behavior patterns (repetitive verbalizations, calling out and unrealistic fears), these behaviors are present and are not easily altered, behavioral symptoms (resists care, socially inappropriate behaviors and verbal abuse) ; requires maximum to total assistance with all activities of daily living; is non - ambulatory, not able to stand without physical help, and is receiving anti-psychotic and antidepressants daily. b) An Interdisciplinary Rehabilitation - Screening dated 11/1/02 identified the resident as having limitations in all areas assessed including positioning. The resident was identified as sliding out of the chair and leans forward while sitting. The Physical Restraint Assessments 7/2/02 through 7/16/03, revealed the resident leans forward, has poor body control and requires a Geri chair for positioning. c) Interview with a staff nurse on the Protective Care Unit at 6:00 P.M. on 7/29/03 revealed the resident is lifted out of the bed with a Hoyer lift. The nurse further stated 2 persons are needed to transfer the resident. The nurse stated the resident is able to sit/lean forward in the recliner chair but is unable to get out of the chair. d) The resident was identified in @ plan of care dated 1/16/03 and 4/16/03 as at risk for falls due to unsteady gait, dementia, poor safety awareness and poor body positioning. The physician ordered the resident to be placed in a Geri chair when out of bed to prevent sliding out. e) During a tour of the facility on 7/29/03 at approximately 10:50 AM, the Assistant Director of Nursing (ADON) stated resident #4 fell in the shower room on the Protective Care Unit. According to facility documentation (nursing notes and investigation of the occurrence), on 7/12/03 at 4:40 P.M., while the resident was in the shower room she/he, "fell out of the shower chair." £) Further review of the 7/12/03's nursing note revealed, the resident was heard screaming in the shower room. A nurse and a CNA went into the shower room to investigate. The CNA who was in the room with the resident stated, "All I did was leave her/him for a second to get towels and she/he fell out of the Chair.", according to the documentation. The resident was sent to the hospital and returned to the facility later that evening. The resident suffered a fractured nose. g) It was observed the facility shower chairs do not have safety belts. The chair is a toilet seat attached to a metal frame with wheels. Prior to the incident the resident was being showered in the shower Chair with the assistance of one person. According to the ADON, the facility has a shower table that has a safety belt. The facility purchased 10 safety belts for the shower chairs on 7/14/03. 10. Based on the foregoing, Stuart Nursing & Restorative Care Center violated Title 42, Section 483.25(h) (2), Code of Federal Regulations as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as a Class II deficiency pursuant to Section 400.23(8) (b), Fla. Stat., which carries, in this case, an assessed fine of $2,500.00 This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). DISPLAY OF LICENSE Pursuant to Section 400.23(7) (e), Florida Statutes, Stuart Nursing and Restorative Care Center Care Center shall post the 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. The Conditional License is attached hereto as Exhibit var 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 $2,500.00 against Stuart Nursing & Restorative Care Center on Count IT. Cc. Assess and assign a conditional license status to Stuart Nursing «6 Restorative Care Center in accordance with Section 400.23(7) (b), Florida Statutes. D. 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 for Health Care Administration, Manchester Building, First Floor, 8355 N. W. 53rd Street, Miami, Florida, 33166; Attn: Nelson E. Rodney. 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. NelsOn E. Rodney Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53 Street Miami, Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 East Tiffany Drive, Suite 100 West Palm Beach, FL 33407 (U.S. Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice Mail) Florida 33166 Skilled Nursing Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) ce cee EXHIBIT “A” Conditional License License No. SNF15260962 Certificate No. 10564 Effective date: 7/29/2003 Expiration date: 12/31/2003

Docket for Case No: 03-004505