STATE OF FLORIDA mm AGENCY FOR HEALTH CARE ‘ADMINISTRATION ‘eh FD D ; | AGENCY FOR HEALTH CARE HAR | 3 Py ADMINISTRATION, Div. 09 SOM MeGN pe Petitioner, HRS Tp vs. Case No. 2ooa000334hiuce oe 2003009211 BELLEAIR EAST HCC, LLC, d/b/a BELLEAIR EAST HEALTH CARE CENTER, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against BELLEAIR EAST HCC, LLC, d/b/a BELLEAIR EAST HEALTH CARE CENTER, (hereinafter “Respondent”), pursuant to Sections 120.569, and 120.57, Florida Statutes (2003), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine against Respondent, in the amount of two thousand five hundred dollars ($2,500) pursuant to Sections 400.102(1) (a) and (d), and 400.23(8) (b), Florida Statutes (2003) [AHCA Case No. 2003009211]. 2, This is an action to impose a conditional licensure rating pursuant to Section 400.23(7) (b), Florida Statutes (2003) [AHCA Case No. 2004000331]. EXHIBIT A 3. The Respondent was cited for the deficiencies set forth below as a result of an appraisal survey conducted on or about December 4, 2003. JURISDICTION AND VENUE 3. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes (2003). 4. venue lies in Pinellas County, Division of Administrative Hearings, pursuant to Section 120.57, Florida Statutes (2003), and Chapter 28-106, Florida Administrative Code (2003). PARTIES 5. AHCA, Agency for Health Care Administration, is the regulatory agency responsible for the 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 (2003), and; Chapter 59A-4, Fla. Admin. Code (2003), respectively. 6. Respondent is a nursing facility located at 1150 Ponce de Leon Blvd., Clearwater, FL 33756. Respondent is licensed to operate a skilled nursing facility pursuant to license #SNF10480962. At all relevant times, Respondent was a licensed facility required to comply with all applicable regulations, statutes and rules under the licensing authority of AHCA. COUNT I RESPONDENT FAILED TO ENSURE THAT A RESIDENT WHO DISPLAYS MENTAL OR PSYCHOSOCIAL ADJUSTMENT DIFFICULTY, RECEIVES APPROPRIATE TREATMENT AND SERVICES TO CORRECT THE PROBLEM. 42 CFR 483.25(f£) (1) (2003), INCORPORATING BY REFERENCE Fla. Admin. Code R. 59A-4.1288(2003) CLASS II DEFICIENCY ISOLATED 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. On or about December 4, 2003, AHCA conducted an appraisal survey at Respondent’s facility. 9. Based on interview and record review, Respondent failed to ensure that a resident who displayed mental and psychosocial adjustment difficulty received appropriate treatment and services to correct the assessed problem for one of one sampled residents (#1) who displayed repeated aggressive actions toward other residents and staff members. Findings: Per the Admission Face sheet, resident #1 was admitted to the facility on July 8, 2003 with diagnoses including cerebral vascular accident, and dementia. The resident's care plan, dated July 17, 2003, identified a problem with "patient exhibiting possible signs and symptoms of delirium”, and on July 19, 2003, a problem of having "a history of sexually inappropriate behavior". Review Notes on the care plan, dated July 23, 2003, read "continues with agitation, combative, inappropriate behaviors". Another Review Note on the care plan, dated August 7, 2003, read "seen by psychiatrist, continues with behaviors". Care Plan approaches were not changed. On September 22, 2003, a new problem was added, "Altered mood with behavioral symptoms present at times due to dementia with psychosis and agitation". The resident was seen by a psychiatrist on August 7, 2003 and again on September 11, 2003, with the result of an addition of the medication Ativan 0.5mg, orally or intramuscularly, twice a day, as needed for agitation. On September 16, 2003, the resident was again seen by the psychiatrist. On September 26, 2003, the Review Notes on the resident's Care Plan stated “resident hit another resident and very agitated. M.D. in and increased medications (Seroquel ordered orally twice a day). Will monitor”. Per nursing documentation September 26, 2003 to present, the resident continued to be agitated and had aggressive behaviors. Per Interdisciplinary Progress, of October 28, 2003, at 8:30 a.m. (late entry), resident #1 was observed in another resident's room at the bedside touching the resident on the stomach and the genitalia area. The resident was seen by the psychiatrist on October 30, 2003, following the incident, and again on November 6, 2003. Resident #1's care plan was updated on November 3, 2003 to address the sexually inappropriate behavior. Per Nursing Progress notes of October 28-December 4, 2003, interventions such as room relocation, psychological assessment, medication changes, redirection, and monitoring have resulted in the reduction of sexually inappropriate behavior. However, the resident continues to exhibit physically aggressive behavior towards other residents in the facility as described in the following Interdisciplinary Progress Notes (IPN): 10/29/03 "Resident strikes out at staff when they attempt to assist with dressing”. “Ativan medication given for yelling, swearing, threatening staff and residents”. 10/30/03, "Resident #1 going into another resident's room, yelling, swearing and threatening resident and resident afraid to go to his/her room." 10/31/03 "Nurse was trying to pull resident’s pants up, resident #1 started swinging, trying to hit everyone, swearing. Ativan given". 11/4/03 "Resident very verbally abuse. Ativan given.” 11/6/03 "Resident has a private sitter for one-on-one monitoring for eight hours a day for seven days. 11/8/03 "Resident very aggressive toward staff and other residents. Resident is sexually aggressive toward females on 400 hallway; refusing to calm". 11/13/03 "Only one outburst at another resident." 11/26/03 “Resident (#1) went into another resident's room, had an altercation which resulted in the other resident having a superficial scratch on the top of his/her hand." On the same day, the resident was "hitting at another resident and swearing at him/her". 11/31/03, at 3:00 a.m., “Resident up in merrywalker, verbally and physically abusive to staff and residents-very nasty when redirected”. 12/02/03, at 10:00 p.m., resident was, "swearing at staff and other residents- threatening to hit them x3”. On December 4, 2003 at 3:00 p.m., interview with resident #1's former roommate revealed the former roommate is "much happier with his/her room". The roommate further stated that resident #1 came into my room (on November 26, 2003) and I told him/her it wasn't his/her room anymore. "He/she came over and grabbed my arm and scratched me. He/she was always that way, threatening to break someone's back or beat them up”. Record review of resident (#1)'s care plan, dated September 22, 2003, documented the problem of "altered mood with behavioral symptoms present at times, due to dementia with psychosis and agitation" identified with a goal of "no decline in mood or escalation of behavior." Per the facility's Abuse and Neglect Prohibition Policy manual (not dated), "residents identified by staff as exhibiting abusive behavior shall have treatment plans modified or additional approaches added to both protect the resident and stop the aggressive behavior.” The care plan has not been updated to address the ongoing problem of aggressive behavior as of December 4, 2003. 10. Respondent was provided a mandated correct ion date of December 7, 2003. 11. The above actions or inactions are a violation of Title 42, Code of Federal Regulations 483.25 (£) (1) (2003), incorporating by reference Rule 59A-4.1288, Florida Administrative Code (2003), which requires the facility to ensure that a resident who displays mental or psychosocial adjustment difficulty, receives appropriate treatment and services to correct the problem. 12. Pursuant to Section 400.23(8) (b), Florida Statutes (2003), the foregoing is a class IT deficiency and as such, has compromised the resident’s ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well- being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class Il deficiency is subject to a civil penalty of $2,500 for an isolated deficiency, $5,000 for a patterned deficiency, and $7,500 for a widespread deficiency. The fine amount shall be doubled for each deficiency if the facility was previously cited for one or more class I or class II deficiencies during the last annual inspection or any inspection or complaint investigation since the last annual inspection. A fine shall be levied notwithstanding the correction of the deficiency. 13. A civil penalty is authorized and warranted in the amount of $2,500, as this violation constitutes an “isolated” Class II deficiency. 14. Pursuant to Section 400.23(7) (b), Florida Statutes (2003), the Agency is authorized to assign a conditional licensure status to Respondent’s facility. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration requests the Court to order the following relief: a. Enter actual and legal findings in favor of AHCA; b. Impose a $2,500 civil penalty against Respondent ; c. Assess costs related to the investigation and prosecution of this case, pursuant to Section 400.121(10), Florida Statutes (2003); d. Uphold the conditional licensure status pursuant to Section 400.23(7) (b) (2003); and e. Grant any other general and equitable relief as deemed appropriate. NOTICE The Respondent is hereby notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes (2003). 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 attention of: Lealand McCharen, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR 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 furnished by U.S. Certified Mail Return Receipt No. 7003 1010 0003 0279 4027, to C.T. Corporation System, 1200 South Pine Island Road, Plantation, FL 33324, dated on February it, 2004. Katrina D. Lacy, Esqu/re AHCA, Senior Attorney Fla. Bar. No. 0277200 Counsel for Petitioner 525-Mirror Lake Dr. N., #330G t. Petersburg, FL 33701 (727) 552-1525 (office) (727) 552-1440 (fax) Copies furnished to: CT Corporation System Registered Agent for Belleair East Health Care Center 1200 South Pine Island Road Plantation, FL 33324 (U.S. Certified Mail) Scott Elsass, Administrator Belleair East Health Care Center 1150 Ponce de Leon Blvd Clearwater, FL 33758 (U.S. Mail) Katrina D. Lacy AHCA - Senior Attorney 525 Mirror Lake Drive, Suite 330G St. Petersburg, FL 33701

Docket for Case No: 04-000997