CY-(87 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Vani 8 PA bs py AL opps STATE OF FLORIDA AGENCY FOR HEALTH CARE : nen ADMINISTRATION AHCA No: 20040680826. .'° Petitioner, Return Receipt Requested . 7002 2410 0001 4237 0287 vs. 7002 2410 0001 4237 0294 7002 2410 0001 4237 0300 AYINTOVE ASSOCIATES, LLC, d/b/a HARMONY HEALTH CENTER, Respondent / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Ayintove Associates, LLC, d/b/a Harmony Health Center (hereinafter “Harmony Health Center”) pursuant to 28-106.111, Florida Administrative Code (2001) (F.A.C.), and Chapter 120, Florida Statutes (“Fla. Stat.”) hereinafter alleges: NATURE OF ACTION 1. This is an action to impose an administrative fine in the amount of two thousand five hundred ($2,500) dollars pursuant to Section 400.23 Fla. Stat. JURISDICTION AND VENUE 2. This court has jurisdiction pursuant to Section 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. 3. Venue lies in Miami-Dade County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207, F.A.C. PARTIES 4, AHCA is the enforcing authority with regard to nursing home licensure pursuant to Chapter 400, Part II, Fla. Stat. and Rule 59A-4 F.A.C. 5. “Harmony Health Center” is a nursing home located at 9820 N. Kendall Drive, Miami, Florida 33176 and is licensed under Chapter 400, Part II, Fla. Stat., and Chapter 59A-4, F.A.C. COUNT I HARMONY HEALTH CENTER FAILED TO ENSURE THAT PERSONAL PRIVACY WAS PROVIDED FOR A RESIDENT WHILE RECEIVING PERSONAL CARE 483.10(e) (3), C.F.R., as incorporated by Rule 59A-4.1288 F.A.C., and/or Section 400.022(1)(m), Florida Statutes (FREE CHOICE) Class II 6. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 7. Because Harmony Health Center Participates in Title XVIII or XIX it must follow the certification rules and regulations found in 42 C.F.R. 483. 8. During a complaint investigation in conjunction with annual survey conducted on 12/01-05/2003 and based on observation, interview and clinical record review the facility failed to ensure that personal privacy for a sampled resident was provided while that resident was receiving personal care {i.e., bathing), which contributed to the resident's feeling of humiliation. The facility also failed to provide privacy while providing care to a sampled resident with tracheostomy (#1) and for randomly sampled resident R50 while they were receiving medications through their feeding tube. Findings include: (a) During a confidential Quality of Life interview with a sampled resident on 12/02/2003 at 10:45 AM, the resident when asked about privacy stated that there is no respect by the staff regarding privacy especially when receiving personal care. The resident continued to state that even though her/his bathroom has a shower they are taken to the shower room for bathing. Once in the shower room the resident stated that usually two residents are bathed at the same time. Also, staff enters the shower room without knocking; they just open the door and walk in. When asked how she/he felt being naked and bathed next to another resident who was also naked and being bathed, the resident stated "very uncomfortable." She/he stated that staff refuses to shower her/him in her/his own bathroom. The sampled resident further stated that on at least one occasion while being showered in the presence of another resident, the second resident had a bowel movement on the floor of the shower room. The resident stated that staff continued to bathe her/him with the feces on the floor. Again, the sampled resident was asked how this made her/him feel and they stated that they "felt very humiliated, like in an old Jewish Nazi camp." The resident reported that he/she preferred that the facility not know of his/her identity due to fear of retribution. (b) Review of the clinical record reveals that the sampled resident was readmitted to the facility on 11/17/2003. The Initial Nursing Assessment dated 11/17/2003 indicates that the resident uses a walker to ambulate. Nurses' notes dated 11/18/2003, 11/19/2003, and 11/25/2003 and through out the record indicate that the resident is alert and oriented to name, time and place. (c) Observation of the shower room on 12/03/2003 at approximately 10:30 AM revealed that upon entering the room there is a tub on the right. There was a 1/3 of a netted curtain pulled around the tub area. In full view of the shower room door were two showers next to each other. There was no shower curtain that could be pulled to provide privacy between each resident being bathed nor was there one that would provide privacy from anyone entering. (d) Interview with the Assistant Director of Nurses (ADON) and the Restorative Nurse on 12/04/2003 at 8:55 AM as to why residents cannot be showered in their own bathrooms revealed that it's easier for the Certified Nursing Assistants (CNAs) to use the shower room. They can push the shower chairs into the room. Also, if the CNAs use the resident's bathroom the resident has to step over the tub and this is difficult for some residents. The Restorative Nurse continued to state that the CNA's are doing this by choice. It's not that they can't use the shower in the resident's room. (e) Review of the clinical record reveals that the sampled resident #1 was readmitted to the facility with the following diagnosis’: S/P pneumonia, COPD, depression, insomnia, S/P tracheostomy, gait disturbance, S/P PEG, S$/P right knee replacement, bilateral hip ORIF and ORIF for cervical canal stenosis. The Initial Nursing Assessment dated 11/17/03 indicates that the resident uses a walker to ambulate. Nurses' notes dated 11/18/2003, 11/19/2003, 11/25/03 and through out the record indicate that the resident is alert and oriented to name, time and place. (£) On 12/05/2003 at approximately 12:00 PM the resident was observed from the hallway to be sitting in a chair next to her/his bed. The surveyor entered the room in order to observe tracheostomy care. The Licensed Professional Staff member neither closed the door to the resident's room nor pulled the privacy curtain while performing this procedure. (g) Interview with the Licensed Professional Staff member on 12/05/2003 at approximately 1:00 PM confirmed that he should have either closed the door to the resident's room or pulled the privacy curtain. (h) During observation of the medication pass on 12/01/2003 while the Licensed Professional Staff member was administering medication through resident R50's feeding tube, the staff member neither closed the door to the resident's room nor pulled the privacy curtain. 9. Based on the foregoing, “Harmony Health Center” violated 483.10(e), C.F.R., and incorporated by Rule 59A- 4.1288, F.A.C., and Section 400.022(({1)(m), Florida Statutes herein classified as a Class II violation, which carries, in this case, an assessed fine of $2,500. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: A. Make a factual and legal findings in favor of the Agency on Count I and B. Assess against “Harmony Health Center” an administrative fine of $2,500 for the Class II violation in Counts I in accordance with Section 400.23(8) (b) Fla. Stat c. 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. D. Grant such other relief as the 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 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, Lealand McCharen, Agency Clerk, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308. Telephone #(850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted. ‘ Agéncy for ith Care Administration Spokane Building, Suite 103 8350 N.W. 52°? Terrace Miami, Florida 33166 Copy to: Diane Lopez Castillo, Field Office Manager Agency for Health Care Administration 8355 N.W. 53™¢ Street Miami, Florida 33166 Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Jean Lombardi, Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 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 Requested to Armando Fernandez, Administrator, Harmony Health Center, 9820 N. Kendall Drive, Miami, Florida 33176; Ayintove Associates, LLC, 6865 N. Lincoln Avenue, Lincolnwood, Illinois 60712, and Norman J. Ginsparg, Registered Agent, 11190 Biscayne Boulevard, North Tower, Miami, Florida 33181 on [Var Gta , 2004. rt Margaref} Juli

Docket for Case No: 04-001187