STATE OF FLORIDA Ch PPB py AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2004001163 AHCA No.: 2004000833 v. Return Receipt Requested: 7002 2410 0001 4237 0447 INTEGRATED HEALTH SERVICES AT 7002 2410 0001 4237 0454 CENTRAL FLORIDA, INC., a/b/a LAUREL 7002 2410 0001 4237 0461 POINTE HEALTH AND REHABILITATION, 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 Integrated Health Services at Central Florida, Inc., d/b/a Laurel Pointe Health and Rehabilitation (“Laurel Pointe Health and Rehabilitation”), pursuant to Chapter 400, Part II, and Section 120.60, Fla. Stat. (2003), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $3,000.00 pursuant to Section 400.23(8), Fla. Stat. (2003), for the protection of the public health, safety and welfare. 2. This is an action to impose a Conditional Licensure status to Laurel Pointe Health and Rehabilitation, pursuant to Section 400.23(7)(c), Fla. Stat (2003). JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2003), and Chapter 28-106, F.A.C. 4. venue lies in St. Lucie County, pursuant to Section 400.121(1) (e), Fla. Stat. (2603), and Rule 28-106.207, Florida Administrative Code. PARTIES 5. AHCA is the reguiatory authority responsible for licensure and enforcement of all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, Part II, Fla. Stat., (2003), and Chapter 59A-4 Florida Administrative Code. 6. Laurel Pointe Health and Rehabilitation is a 107-bed skilled nursing facility located at 703 29 Street, Florida 34947. Laurel Pointe Health and Rehabilitation is licensed as a skilled nursing facility; license number SNF11600961 certificate number 11134, effective 01/08/2004 through 11/30/2004. Laurel Pointe Health and Rehabilitation 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 Laurel Pointe Health and Rehabilitation 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 LAUREL POINTE HEALTH AND REHABILITATION FAILED TO DEVELOP A COMPREHENSIVE CARE PLAN\ FOR EACH RESIDENT THAT INCLUDES MEASURABLE OBJECTIVES AND TIMETABLES TO MEET A RESIDENT’S MEDICAL, NURSING, AND MENTAL AND PSYCHOSOCIAL NEEDS THAT ARE IDENTIFIED IN THE COMPREHENSIVE ASSESSMENT TITLE 42, SECTION 483.20(k), Code of Federal Regulations, incorporated by Rules 59A-4.1288, and 59A-4.109(1), F.A.C. (RESIDENT ASSESSMENT) UNCORRECTED CLASS III DEFICIENCY 8. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 9. During a complaint investigation conducted on 11/24/2003 and based on record review and interview the facility did not develop care plans that were comprehensive for two residents in a sample of ten residents. For Residents #1 and #5 there was no care plan completed after the residents returned from the hospital for monitoring respiratory status in order to avoid a decline in respiratory status. 10. Resident #5 was admitted to the hospital on 10/13/2003 for respiratory problems. The resident was readmitted to the facility from the hospital on 10/20/2003. The new hospital diagnoses for the admission of 10/13/2003 to 10/20/2003 were: pneumonia, congestive heart failure, hypoventilation and respiratory failure. This resident was again admitted to the hospital on 11/19/2003 for respiratory distress and shortness of breath. On the date of the complaint investigation, the resident was still hospitalized, and the resident was on a bed hold status. On 11/24/2003 the comprehensive resident care plan for this resident was reviewed. This review revealed there was no care plan completed by the facility after the resident returned from the hospital on 10/20/2003 for how the nursing staff was going to monitor the resident’s respiratory status, and how the nursing staff was going to monitor the resident for symptoms of an exacerbation of congestive heart failure. (a) At 6 PM on = 11/24/2003, the MDS/Care Plan Coordinator was asked who would be responsible for completing a care plan for a resident on return from the hospital, she stated the nurse manager of the unit would complete a care plan to address new diagnosis and problems. The Director of Nursing stated it would be the responsibility of both the unit manager and the care plan coordinator. The lack of care planning and nursing assessment (cross Count II) potentially contributed to an avoidable decline in respiratory status of this resident and re-hospitalization of this resident on 11/19/2003. 11. Resident #1 was readmitted to the facility from the hospital on 11/12/2003. The nurse practitioner documented in her 4 note, dated 11/19/2003, that the hospital diagnoses were respiratory failure and urinary tract infection. The physician documented diagnoses on the history and physical, dated 9/28/2003 as: respiratory failure, recurrent pneumonia, permanent vegetative state, tracheostomy, gastrostomy tube and urinary tract infection. The clinical record was reviewed on 11/24/2003. The interim care plan did not address monitoring of the resident's respiratory status and interventions to prevent a decline in respiratory status of this resident. The nurses’ notes did not contain documentation of respiratory assessments (cross reference Count II). Correction date: December 24, 2003 12. During the revisit conducted on 01/05-08/2004 and based on record review, it was determined that the facility did not develop care plans to meet each resident's medical and nursing needs, for 1 of 20 sampled residents (Resident #14). 13. Resident #14 receives dialysis services and the facility did not provide a comprehensive care plan including, the facility requirement to ensure medications were given at times for maximum effect. The facility did not ensure detailed infection control procedures and detailed procedures for the management of this resident's shunt/fistula. (a) Resident #14 was on a 1500cc (daily) fluid restriction. The dietary care plan provided for nursing to be responsible for the administration of 780cc and dietary to be 5 responsible for the administration of 720cc of the allotted fluids. However, there is no method in place to ensure nursing was administering and tracking the amount of fluids offered or consumed by the resident. 14. Based on the foregoing, Laurel Pointe Health and Rehabilitation violated Title 42, Section 483.20(k) Code of Federal Regulations as incorporated by Rules 59A-4.1288, and 59A-4.109(1), Florida Administrative Code, herein classified as an uncorrected Class III deficiency pursuant to Section 400.23(8)(c), Fla. Stat., which carries, in this case, an assessed fine of $1,000.00 This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). COUNT II LAUREL POINTE HEALTH AND REHABILITATION FAILED TO PROVIDE OR ARRANGE SERVICES THAT MEET PROFESSIONAL STANDARDS OF QUALITY Title 42, Section 483.20(k) (3) (i), Code of Federal Regulations, incorporated by Rule 59A-4.1288, Florida Administrative Code (RESIDENT ASSESSMENT) UNCORRECTED CLASS III DEFICIENCY 15. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 16. During the complaint investigation conducted on 11/24/2003. and based on record review and interview, the facility did not provide or arrange services that met professional standards of quality for three resident in a sample of ten residents (Residents #1 #5, and #9). Resident #5 had no nursing documentation of respiratory assessments before and after hospitalization on 10/13/2003 or that oxygen saturation levels were completed as ordered by the physician. Resident #1 did not have documentation that all medications were given as ordered by the physician, and the nurses did not document assessments of the resident's respiratory status. Resident #9 did not receive care that met professional standards for the care of an indwelling urinary catheter. 17. The nursing textbook Fundamentals of Nursing Concepts Process and Practice, Sixth Edition by Kozier, Erb, Berman and Burke, publisher Prentice Hall 2000 documents the following purpose and procedure for respiratory assessment of clients/patients/residents at risk for respiratory compromise: (a) Page 519 and 520 Purpose and Procedure 28-5 Assessing Respirations PURPOSE -To acquire a baseline against which future measurements can be compared. -To monitor abnormal respirations and respiratory patterns to identify changes. -To monitor clients at risk for respiratory alterations. PROCEDURE /INTERVENTION 2. Observe, palpate and count the respiratory rate. Place a hand against the client’s chest to feel the client's chest movements. Count the respiratory rate for 30 seconds if the respirations are regular. Count the respirations for 60 seconds if the respirations are irregular. An inhalation and an exhalation count as one respiration. 3. Observe depth, rhythm and = character of respirations. Observe the respirations for depth by watching the movement of the chest. During deep respirations a large volume of air is exchanged; during shallow respirations a small volume of air is exchanged. Observe respirations for regular and irregular rhythm. Normally respirations are evenly spaced. Observe the character of respirations-the sound they produce and effort they require. Normally respirations are silent and effortless. 4. Document and report pertinent assessment data. (b) Page 1261 Pulse Oximetry A pulse oximeter is a noninvasive device that measures the oxygen saturation/Sao2 (the amount of oxygenated hemoglobin in arterial blood. The pulse oximeter is connected to the client's finger. It can detect hypoxemia before clinical signs and symptoms develop, such as dusky skin color and dusky nail beds. Because pulse oximetry measures only the amount of hemoglobin that is bound with oxygen, it can create misleading results if the client's hemoglobin is bound to another substance. An oxygen saturation of 95 to 100% is normal, below 70 is life threatening. 18. Resident #5 was admitted to the hospital 10/13/2003 for respiratory problems. The nurse’s note on 10/13/2003 at 11:45 documented that the resident had labored respirations and that respirations were 40 and oxygen saturation was 48%. The notes of 10/09/2003 documented that the resident had upper respiratory symptoms, and the notes on 10/10/2003 documented anxiety. On 10/10/2003 no lung sounds or oxygen saturation were completed. There were no nurse’s notes for 10/11 or 10/12. The new hospital diagnoses for the admission from 10-13- 2003 to 10-20-2003 was: pneumonia, congestive heart failure, hypoventilation and respiratory failure. This resident was again admitted to the hospital on 11/19/2003 for respiratory distress and shortness of breath. The nurse’s note of 11/19/2003 documented that the oxygen saturation for the resident was 88%. On the date of the complaint investigation, the resident was still hospitalized and the resident was on a bed hold status. On 11/24/2003 the clinical record was reviewed to ascertain if the nurses had assessed the resident's respiratory status prior to the hospitalization on 10/13/2003, and after readmission from the hospital on 10/20/2003 and prior to the re-hospitalization of the resident on 11/19/2003. This review revealed that the nurse’s notes did not document any respiratory assessments prior to the hospitalization on 10/13/2003, and after readmission from the hospital on 10/20/2003, or prior to the re-hospitalization of the resident on 11/19/2003. 19. The Director of Nursing stated that at 6 PM on 11/24/2003, she had counseled a nurse for not documenting a respiratory assessment prior to the hospitalization on 10/13/2003. 20. This resident had a physician's order for the oxygen saturation rate to be monitored every shift. The nurses were documenting the oxygen saturation rate in the nurse’s notes and on the documentation record and profile. The following dates and shifts had no documentation in the nurse's notes or on the documentation record and profile of the oxygen saturation rate being completed. The 7-3 shift, dates 11/3, 4, 5, and 7. The 3-11 shift, 10/31, 11/1,15, and 11/18. The 11-7 shift, 11/1 and 7. 21. Resident #1 was readmitted to the facility from the hospital on 11/12/2003. The nurse practitioner documented in her note, dated 11/19/2003, that the hospital diagnoses were respiratory failure and urinary tract infection. The physician documented diagnoses on the history and physical dated 9/28/2003 as: respiratory failure, recurrent pneumonia, permanent vegetative state, tracheostomy, gastrostomy tube and urinary tract infection. The clinical record was reviewed on 11/24/2003; the nurse’s notes did not contain documentation of respiratory assessments completed by the nursing staff. On 11/16/2003 on the 3-11 shift, the nurse documented that the resident had "lip with color purple" " oxygen saturation 83%". She further documented that the resident was suctioned and that the oxygen saturation 10 improved. No respiratory assessment was documented as done at this time. 22. This resident had orders from the physician for the corticosteroid medication Prednisone to be administered. The medication administration record contained no documentation that the medication was administered on November 20, 21, 22 or 23. 23. Care for indwelling urinary catheters includes 1) Never pull on the catheter. Pulling on the catheter can cause injury to the urethra and the bladder wall. It can also expose a section of the catheter that was inside the urethra so that when the catheter is released the newly contaminated section will reenter the urethra introducing potentially infectious organisms. 2) The catheter is to be kept taped or secured to the patients thigh this is a.) in females to prevent tension on the urogenital trigone. b.) in males, to prevent pressure on the urethra at the penoscrotal junction. (Source p.920, p.925 SPRINGHOUSE Handbook of Clinical Skills 1997). 3) Never allow the catheter tubing to touch the floor. (Source p 602 Lippincott Manual of Nursing Practice 2nd Edition). 24. Based on interview with Resident #9 and review of the facility nursing procedure for indwelling catheters, the facility nursing staff did not ensure that catheters were anchored to the resident's thigh or abdomen. On 11/24/2003, Resident #9 was sitting in the hall in his/her wheelchair. The Bl resident was wearing shorts and was observed to have a catheter. The resident was asked about the catheter (an indwelling urinary catheter) and if it was taped to his/her thigh or abdomen. The resident stated the nurses taped it at the beginning but no more. He/she stated that he/she had never refused to have the catheter taped to the abdomen or thigh. 25. During a tour on 11/24/2003 at 12:35 pm resident #2 was observed, in bed, to have an indwelling urinary catheter. The catheter tube was not secured to the resident and the drainage tubing was not secured to the bed in any way. Correction date: December 24, 2003 26. During the revisit conducted on 01/08/2004 and based on observation, record review, and interview, it was determined that the facility failed to provide or arrange services that met professional standards of quality for 6 of 27 sampled and random residents (Residents #5, #6, #13, #14, #15, and #25). 27. During the review of the clinical record of Resident #15 on 01/06/2003, a readmission date of 12/8/2003 was noted and diagnoses included acute renal failure and end stage renal disease. Further review of the clinical record revealed that the resident was transferred to a dialysis center on Monday, Wednesday, Friday, and was out of the facility on those days from approximately 10:30 AM to 4 PM. A review of medication orders and review of December 2003 and January 2004 Medication 12 Administration Records (MAR) revealed that the resident was not being administered the 12 noon dose of Phoslo (2 tabs 3 times per day with meals), and the 10 AM dose of Norvasc (10mg every morning) was held on 12/26/2003 and 12/31/2003 without a physician's order. An interview with the facility DON on 01/06/2004 revealed that the facility failed to inform the physician that the resident was not being administered the Phoslo, and the facility failed to review all medications ordered on dialysis days for timeliness and effectiveness. 28. Review of the record of Resident #5 revealed a physician's order, dated October 17, 2003, to put heel protectors on the resident. The resident was assessed as at risk for the development of pressure sores due to bed mobility and a history of pressure sores. The physician's orders for the heel protectors were carried over and continue to the present date. Review of the nursing treatment orders for January 2004 revealed that the staff was to place heel protectors on the resident. Observations made by the surveyor on January 05, 2004, from 12:00 P.M., until 3:00 P.M., revealed that the resident had no heel protectors on. The resident stated at 12:00 P.M., that he/she knew they should be on, but the staff had not put them on that day. The unit manager was interviewed at 3:15 P.M., and asked why the heel protectors were not on. It was stated that they probably were lost in laundry. The unit manager went and 13 put new ones on the resident. The staff failed to follow the physician's orders for the prevention of skin breakdown by not applying the resident's heel protectors. 29. Review of the record of Resident #13 revealed physician's orders initiated on April 13, 2003, for staff to perform weekly skin checks. Review of the resident's record revealed that the skin checks were not completed by staff on a consistent basis. There were no documented skin checks on September 22, October 06, October 13, October 20, October 27, November 03, November 10, November 17, November 24, December 01, December 08, December 15, December 22, or December 29, 2003. The unit manager was asked on January 06, 2004, if there was evidence of the skin checks elsewhere in the record, but none could be provided. It was unknown why the skin checks were not completed. Staff did not follow physician's orders for the assessment of the resident's skin. 30. During record review of Resident #14, it was determined that medications were documented as administered when the resident was at another medical facility receiving dialysis, and that another medication was not held per physician's order. (a) The physician's order read Tums 500mg 1 PO (by mouth) with meals TID (3 times daily- breakfast, lunch, dinner). The MAR reflected that this medication was administered at 4 11:30am on December 22, 24, 26, 31, 2003 and January 2, 2004. Resident #14 was at the dialysis center during this time. (b) The physician order read Dulcolax 5mg tab PO BID (2 times daily) hold stool softener the night before dialysis (Monday, Wednesday and Friday) . The MAR did not contain the documentation to reflect the doses, to be held per the physician's order. (c) During the medication pass on 1/6/2004, on the 200 hall the surveyor was observing the medication nurse pour medications at 9:00 a.m. for Resident #6. Resident #6 had a gastrostomy tube and required all medications to be liquids, crushed, or opened capsules. The nurse approached the resident, pulled the curtain, and then turned the machine off. There was no covering put over the resident, where the gastrostomy tube entered into the stomach area. The nurse then disconnected the tubing, without clamping, thus allowing air to enter into the stomach, and placed the syringe into the tubing. He/she then pushed some air into the stomach and then pulled back on the syringe, aspirating some stomach contents. The nurse did not listen for placement of the gastrostomy tube, by placing the stethoscope over the stomach area, while pushing air into the gastrostomy tube. The stomach contents were then taken and emptied into the sink in the resident's room. The nurse came back to the resident's bedside, and picked up the Neurontin 15 300mg. capsule, and opened it. When the nurse was pouring the Neurontin capsule contents into the medication cup, part of the contents spilled onto the pedside table. The nurse poured water into the medication cup, mixed up the medication, poured the medication into the syringe, and placed the syringe into the gastrostomy tube. The nurse then placed the barrel into the syringe, and forced the medication down the syringe. When the medication was given, he/she flushed behind the medication with 100cc of water (physician order for 12/30/03 was 60cc before and after medications) . 31. On the 200 hall, during the medication pass at 9:22 a.m., the surveyor observed Resident #25 being given his/her medications by the medication nurse. The nurse obtained the medications from the medication cart and opened the blister packs. When the medication pass was completed, the surveyor went to the nurses’ station to verify the medications given with the physician’s orders. When the surveyor reviewed the orders, he/she noted that Colace had not been given. The surveyor approached the medication nurse, and asked if he/she had forgotten, or was this set up on a different time? The medication nurse stated, "No, f didn't forget, and it is to be given at 9:00a.m. We had no Colace, so the resident will receive the Colace tomorrow (1/7/2004)". The surveyor and two other surveyors interviewed the Director of Nursing and the 16 Nurse Consultant regarding the Colace. They both stated, "This is a stock medication, and we have Colace here in the facility." The Colace was given to the resident, upon surveyor intervention. 32. Resident #1 was re-admitted to the facility on 12/23/2003 from the acute care hospital. The resident was admitted with the following diagnosis: congestive heart failure, atrial fibrillation, hypertension, advanced multiple sclerosis, renal failure, bilateral above the knee amputation, hyperlipidemia, hypovolemia, decubitus ulcer's, anemia, cardiomyopathy, neurogenic bladder, depression, contractures, and Peripheral vascular disease. 33. Review of the resident's initial Care Plan, dated 12/23/2003, which was incomplete, revealed the following: (a) The care plan for Decreased ADL (activities daily living), did not address the problems related to bilateral hand contractures, nor above the knee amputations. The resident required total care in all areas of activities of daily living. He/she was unable to use his/her hands, due to contractures. He/she could not attend exercise, unless staff took the resident to exercise. (b) Foley catheter care plan did not address how the catheter was to be cared for by staff. Nor did it specify how much fluid the resident was supposed to have each day, or how 17 the amount was going to be recorded. The care plan did not address how often the catheter was to be changed, or the bag was to be changed, nor who was responsible for doing these things. The care plan did not address the signs and symptoms of a urinary tract infection. (c) The care plan for a pressure ulcer, skin alteration to right and left hips, did not address that the resident has two stage IV's and one stage II pressure ulcers and their locations. It did not address the size of the pressure ulcers and what the facility would do to decrease the size of the ulcers. The care plan did not address the treatment plan for the care of the pressure sores, pressure neither ulcer measurable, nor who was responsible. The care plan did not address the potential for other pressure areas on the resident and where these areas might occur. (a) Care plan for gastrostomy tube did not address a protocol for checking for the G-tube placement. The care plan did not address the amount of water needed prior to medications and feedings. There was no specific amount for residual, for which the physician needed to be called. What were the unusual findings? Did not address what facility protocol was to clean around the G-tube. (e) Falls: No care plan (£) Dental Care: No care plan 18 (g) Psychotropic drug use: No care plan 34. Based on the foregoing, Laurel Pointe Health and Rehabilitation violated Title 42, Section 483.20(k) (3) (i) Code of Federal Regulations as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as an uncorrected Class III deficiency pursuant to Section 400.23(8)(c), Fla. Stat., which carries, in this case, an assessed fine of $1,000.00 This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). COUNT III LAUREL POINTE HEALTH AND REHABILITATION FAILED TO ESTABLISH AN INFECTION CONTROL PROGRAM UNDER WHICH IT INVESTIGATES, CONTROLS, AND PREVENTS INFECTIONS IN THE FACILITY; DECIDES WHAT PROCEDURES, SUCH AS ISOLATION, SHOULD BE APPLIED TO AN INDIVIDUAL RESIDENT; AND MAINTAINS A RECORD OF INCIDENTS AND CORRECTIVE ACTIONS RELATED TO INFECTIONS Title 42, Section 483.65(a) (1)-(3), Code of Federal Regulations, as incorporated by Rule 59A-4.1288, Florida Administrative Code (INFECTION CONTROL) UNCORRECTED CLASS III DEFICIENCY. 35. AHCA’ re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 36. During the complaint investigation conducted on 11/24/2003 and based on observation during a tour of the facility on 11/24/2003, the facility staff did not implement practice that prevented the potential for infections in residents. Oxygen cannula and tubing were not dated, catheter bags were not dated, and a suction catheter and tubing was not dated. 37. The nursing textbook Fundamentals of Nursing Concepts Process and Practice Sixth Edition by Kozier, Erb, Berman and Burke, publisher Prentice Hall 2000 documents on page 636 a method of ” transmission of infection can be a fomite (an inanimate materials or objects). " Oxygen masks, oxygen tubing, suction catheters and any medical purpose tubing or device become fomites when contaminated with blood and body fluids as they provide a medium for the growth of pathogens (germs) . 38. During a tour of the facility on 11/24/2003 between 12 noon and 1 pm the following was observed by the surveyor: 39. There was no date on the water bottle, the oxygen concentrator, or the oxygen tubing attached to the tracheostomy for Resident #10. There was a suction catheter attached to the suction bottle. The catheter was not dated, and it was on the floor. 40. The oxygen tubing attached to the connector tracheostomy for Resident #10 was not dated. 41. The oxygen cannula and tubing for resident #6 was not dated. 42. The oxygen cannula, tubing and the urinary drainage bag for Resident #2 was not dated. 20 43. The urinary drainage bag for Resident #7 that was not dated. 44. The oxygen cannula and tubing of the portable oxygen attached to the wheelchair of Resident #8 was not dated. The oxygen cannula and tubing on the oxygen concentrator at the bedside was not dated either. Correction date: December 24, 2003 45. During the revisit conducted on 01/08/2004 and based on observation and interview, during the 1/05/2004 through 01/08/2004 survey, it was determined that 3 of 20 sampled residents were not cared for in a manner which would help decrease the risk of infection in residents with gastrostomy tubes (Residents #1, 6, and 16). 46. During the medication pass of Resident #1 on 01/06/2004 at 9:10 a.m. on the 200 hall, the surveyor observed the medication nurse administer medication through a gastrostomy tube, without first laying a cover over the abdominal area to catch any spillage. Contents of the stomach, which had been aspirated into the syringe, were pushed out of the syringe into the sink by the medication nurse. The medication nurse did not clean the syringe, or the barrel of the syringe, before storing them in a plastic bag, leaving a soiled syringe in an environment where bacteria could rapidly grow. 21 47. The surveyor observed the same process with the gastrostomy tube of Resident #6 at 9:00 a.m. and Resident #16 at 9:17 a.m. The medication nurse used the same protocol with all three residents. While in the residents’ rooms, the surveyor observed the feeding pumps and observed beige/brown/dry material on the machine top and down the sides. This was brought to the attention of the Director of Nursing (DON) and the Nurse Consultant. The surveyor also discussed with the DON and Nurse Consultant, the issue of the nurse disposing of the stomach contents into residents' sinks and not properly cleaning the syringe and barrel before storing them in the plastic bag. 48. Based on the foregoing, Laurel Pointe Health and Rehabilitation violated Title 42, Section 483.65(a) (1)-(3) Code of Federal Regulations as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as an uncorrected Class III deficiency pursuant to Section 400.23(8)(c), Fla. Stat., which carries, in this case, an assessed fine of $1,000.00 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, Laurel Pointe Health and Rehabilitation shall post the license in a prominent place that is in clear and unobstructed public view at 22 or near the place where residents are being admitted to the facility. The Conditional License is attached hereto as Exhibit “A” 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 Counts I, II and IIf. B. Assess an administrative fine of $3,000.00 against Laurel Pointe Health and Rehabilitation on Counts I, II and III. c. Assess and assign a conditional license status to Laurel Pointe Health and Rehabilitation 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 23 Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida 32308, attention Lealand McCharen, Agency Clerk. Telephone (850) 922-5873. 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. elIson E. Rodney Assistant General Counsel Agency for Health Care Administration 8350 N. W. 5254 Terrace, Suite 103 Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 Bast Tiffany Drove, Suite 100 West Palm Beach, Florida 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) Skilled Nursing Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) EXHIBIT “A” Conditional License License No. Effective date: 01/08/2004 Expiration date: 11/30/2004 25 SNF11600961 Certificate No. 11134

Docket for Case No: 04-001189