cy ed STATE OF FLORIDA . ome AGENCY FOR HEALTH CARE ADMINISTRATION — ate ahy STATE OF FLORIDA 04 APR -8 PHL: 15 AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, : vs. Case Nos. 2003006322 2004001482 SARASOTA WELFARE HOME, INC., d/b/a PINES OF SARASOTA, 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 Sarasota Welfare Home, Inc., d/b/a Pines of Sarasota, pursuant to §§ 120.569, and 120.57, Fla. Stat. (2003), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of Twelve Thousand Five Hundred Dollars ($12,500), impose a conditional license status commencing 08/14/03 and a survey fee of Six Thousand Dollars ($6,000) based upon Pines of Sarasota's failure to ensure each resident receives adequate supervision and assistance devices to prevent accidents. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Fla. Stat. (2003). 2. Venue lies pursuant to Fla. Admin. Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of nursing homes and enforcement of 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; Fla. Admin. Code R. 59A-4, respectively. 4. Pines of Sarasota operates a 204-bed nursing home located at 1501 N. Orange Avenue, Sarasota, Florida 34236, and is licensed as a skilled nursing facility, license number SNF590700567. 5. Pines of Sarasota was at all times material hereto, a licensed nursing 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 42 CFR § 483.25(h)(2) and Fla. Admin. Code R. 59A-4.1288 Pines of Sarasota must ensure that each resident receives adequate supervision and assistance to prevent accidents. 8. On or about 08/11/03, the Agency conducted a Health and Fire Life Safety licensure and certification survey of Pines of Sarasota. 9. Based on observation, clinical record review and interviews with residents, Administrator, Director of Nursing, Nursing Consultant and Chief Operating Officer, and review of the facility’s policy and procedures, the facility staff has failed to ensure 7 of 14 (Residents # 2, # 7, # 25, # 10, # 26, # 31 and # 19) smoking residents were monitored and adequately supervised per their smoking assessments to prevent smoking related accidents to themselves and other non-smoking residents of the facility. 10. Facility staff failed to provide the designated smoking area with a fire sprinkler system. 11. Resident # 25 was observed during tour of the facility on 8-11-03 burning her dress, twice, with a lit cigarette. “412. Failure to assess the ability to safely smoke cigarettes for Residents # 10, # 25, #19 and # 31 resulting in burn holes in clothing. 13. Failure of facility staff to intervene and assist as necessary residents assessed by the staff to be a danger to themselves and the other non-smoking residents as evidenced by the facility staff failing to follow the smoking assessment for the residents identified as smokers. 14, Surveyors observations in residents’ rooms, located in both sections of the facility, (the main building and the pods) where cigarettes and lighters were available to Residents # 10 and # 2 assessed as not capable of safely storing or using smoking items. 15. Review of Residents # 25, # 10 and # 2 smoking assessments and care plans, not being followed by facility staff. 16. Facility staff unaware, until surveyor intervention, that a cognitively impaired Resident #31 was smoking cigarettes. 17. Staff allowed Residents #10 and #26 to smoke unattended even though they are aware that the residents dispose of lit cigarettes in trashcans, and smoke in non-designated smoking areas. 18. Facility allowed residents to smoke in an area not covered by fire sprinkler system as is required. 19. The facility's failure to provide adequate supervision, assessment and care planning of these residents caused a situation that, if not immediately corrected, could cause great harm or death to these and all residents. 20. On 8-11-03 at approximately 10:55 a.m., the surveyor observed Resident # 25 seated in a wheelchair in the covered smoking section, adjacent to the Veranda building. 21. The surveyor sat next to the resident on her right side. 22. The resident removed a cigarette from a pack and lit it with a lighter. The resident had the cigarette hanging from her lips. "23. The resident's neck was in a forward-flexed position. 24. The resident reached down to the right of her wheelchair to place an article in her bag. 25. At this time the end of the lit cigarette, which had been dangling from her lips, touched the front of her synthetic housedress and melted a hole into it. 26. The resident sat back up and the cigarette released itself from the fabric. 27. Immediately after, the resident again bent over to place the lighter in her bag and again the end of the lit cigarette melted a hole in the material. 28. The cigarette actually stuck momentarily to the fabric as the resident raised her head. 29, The burned area was approximately 1 centimeter oblong. 30. The surveyor noted a cluster of burn holes in the resident's housedress. 31. The holes extended from just below the neck of the dress, spread out approximately 4 inches across and 3 inches vertically. 32. The resident was not wearing any type of smoking protector. 33. The surveyor noted a staff member seated in the area, also smoking a cigarette. 34. The staff member was not noted to be observing the resident. 35. At approximately 11:12 a.m., the survey team requested a meeting with the Administrator and Director of Nursing (DON). 36. Atthis time, the team requested a list of all residents who smoke and the facility's policy and procedure on smoking. 37. When the list of residents who smoke was obtained, the team split up and with a staff member present, interviewed the residents and with residents’ permission, did an observation of each residents’ room and content. 38. At approximately 1:24 p.m., the survey team reconvened and the surveyors’ observations were discussed. 39. The Minimum Data Set (MDS), Care Plan, Initial Smoking Assessments and. review of Medication Administration Records were reviewed throughout the day of 8/11/03 for each resident. 40. At approximately 12:10 p.m., Resident # 25 was observed to have a lighter on her nightstand. 4l. The surveyor noted 7 articles of clothing with multiple burn holes present. 42. The articles consisted of 5 housedresses and 2 blouses. 43. The burn holes ranged from the size of the tip of a pencil to that of a pencil eraser. 44, Review of Resident # 25's clinical record revealed the resident had been recently re-admitted to the facility following a hospital stay for a urinary tract infection (UTI). 45. The resident's most recent admission date was 5-19-03. 46. The resident has multiple diagnoses including but not limited to Depression, Psychosis, Anxiety, Schizophrenia, Coronary Artery Disease and Diverticulitis. 47. Review of the Medication Administration Record (MAR) revealed the resident was taking Buspar, Risperdal, and Remeron. Side effects for these three medications include drowsiness. 48. The most current MDS, dated 5-23-03 and completed for a significant change in status following hospitalization for a UTI, was reviewed. 49. The Resident's cognition level, Section B. 4. = 2. Moderately impaired - decisions poor; cues/supervision required. 50. Section B. 5., indicators of delirium - periodic disordered thinking/awareness = b. Periods of altered perception or awareness of surrounding (e.g.), moves lips or talks to someone not present; believes he/she is somewhere else; confuses night and day. 2. Behaviors present, over last 7 days appear different from resident's usual functioning (e.g., new onset or worsening). 51. Section B. 6. Change in cognitive status = 2. Deteriorated. 52. Section E. 1. Indicators of depression, anxiety, sad mood = c. Repetitive verbalizations. 1. Indicator of this type exhibited up to 5 days per week. 53. Section e. 4. Behavioral symptoms = e. Resists care. 1/0 - Behavior of this type occurred 1 ‘to 3 days in last 7 days/Behavior not present or behavior easily altered. 54. Section E. 5. Change in behavioral symptoms =- 2. Deteriorated. 55. Section G. 4. Functional limitation in range of motion = a. Neck 2/1 - Limitation of both sides/Partial Loss. 56. Section G. 9. Change in ADL (Activity of Daily Living) = 2. Deteriorated. 57. Section Q. 2. Overall change in care needs = 2. Deteriorated - receives more support. 58. The resident care plan, dated 5-29-03, reads: "Decline in mobility activities including gait secondary to diagnosis with recent hospitalization. History of falls, due to poor safety awareness, unsteady gait. Ia cigarette smoker at risk for injury." Goals for smoking: "----- will have no smoking related incidents or injuries." Approaches include: "1. Smoking assessment completed. 2. Reinforce smoking only in designated areas. 3. To wear smoking apron. 4. Report any observed unsafe smoking behaviors such as sleeping with a lit cigarette, dropping ashes on clothing, or lighting a cigarette in a non-smoking area." 59, The most current smoking assessment on the resident's chart, dated 8-30-02, reads the resident is alert and oriented, has fine motor control and understands facility-smoking policies. 60. However, listed under - History of Smoking Related Incidents - "Drops ashes on self” is checked off and next to this is written, "frequent holes noted in clothes.” 61. Interventions include only smoking apron. 62. Included in this section is an area - Independent - that is not checked off. 63. At approximately 1:35 p.m., Resident # 25 was again observed in the Veranda smoking area. 64. Interview with the resident revealed she does wear a smoking apron but over the weekend and until the time of the survey, she was without one because it was in the wash. When asked why she needed a smoking apron, the resident stated, "I go to sleep. Cigarettes hit my clothes.” 65. The staff nurse confirmed the aprons are sent to laundry for cleaning. 66. On 8-12-03, the facility completed an updated smoking assessment for Resident # 25. 67. Cognition = Alert and oriented, no confusion or memory loss. 68. The resident has impaired vision. 69. The resident has a history of burning clothes and dropping ashes on self. 70. The resident is now deemed unable to smoke unattended. 71. Written instructions for staff includes: Smokes with supervision only. Must wear smoking apron. 72. Resident # 7 (identified by the facility as a smoker) was admitted to the facility on 4/10/98 with diagnoses of: Hypothyroidism, Hypertension, Peripheral Vascular Disease, Arthritis, Osteoporosis, S/P Cerebrovascular Accident, Hemiplegia, Emphysema, and Anemia. 73. On 8/11/03 at approximately 11:55 a.m., Resident # 7 gave permission to examine the clothing in her room for any signs of cigarette burns. 74. With a facility staff nurse present, one shirt was found with multiple cigarette burns. 75, These were all noted to be on the front and lower part of the shirt. 76. There were three lighters, 4 packs of Marlboro cigarettes, and 12 empty cigarette packs on the top of the bedside stand. These were visible from the doorway to the room. 77. The staff nurse informed the surveyor that the facility does the resident's laundry. The resident's clothing never leaves the facility. 78. Aninterview with Resident # 7 on 8/11/03 at approximately 1:30 p.m., revealed that the resident hates to use the smoking aprons and he/she throws them away. 79, The resident stated that he/she does not burn him/her self and carries a lighter in his/her pocket all the time. 80. The resident uses a wheelchair and is able to move about the facility without assist from the staff. 81. It was observed that the resident is alert and has use of left hand only with a left index-finger contracture on the left hand. 82. The MDS dated 7/02/03, indicates the resident is independent in making decisions but they are "poor decisions.” 83. Resident has clear speech, can understand others and has impaired vision. 84. The resident displays socially inappropriate behavior and prefers to "defecate" in briefs rather than interrupt smoking to go to the bathroom. 85. The resident is totally incontinent of bowel and bladder related to refusal to use commode or toilet. 86. Acare plan dated 7/01/03, states the resident is a smoker and handles his/her smoking materials. 87. The approach to the problem is to monitor for indications of unsafe smoking, such as burn holes in clothing or falling asleep during smoking. Remind him/her to use safe practices when smoking and continue to encourage wearing smoking apron. 88. Following surveyor intervention, an updated Smoking Assessment dated 8/1 1/03 for Resident # 7, states the resident, "Has tar stained fingers. Can only use (L) arm due to right-sided weakness from CVA- left index finger contracted. 89. This final assessment dated 8/11/03 states the resident will now "need supervision and a smoking apron." 90. During an interview on 8/12/03 at approximately 2:00 P.M., the Licensed Practical Nurse (LPN) stated this resident's cigarettes are kept in the bottom of the Med Cart, "as of yesterday (8/11/03)." 91. Observations of this resident during the morning of 8/14/03, after surveyor intervention and an updated assessment showed the resident had a smoking apron in place and staff was present when the resident was smoking. 92, Resident # 20 was admitted to the facility on 8/3/99 with a diagnosis of Subdural Hematoma, Seizure Disorder, and Carotid artery Disease. 93. On 8/11/03, during inspection of his clothes with his permission it was noted that he/she did not have any burn holes. 94, At 12:25 p.m., in an interview with this resident, he/she stated, "I watch other residents and if they fall asleep I wake them up. The staff is not always out here.” 95. The resident's MDS dated 6/05/03, for cognition skills for daily decision-making was coded as a | (modified independence). 96. His/her care plan states 1. Monitor smoking activity in order for him/her to be safe with cigarettes. 2. Remind him/her to smoke in designated areas only. 3. He/she often does have warning prior to seizure activity. Remind him/her to extinguish cigarettes when he/she feels a seizure coming on. 97. On the smoking assessment it reads that he/she is independent in interventions and alert and oriented in cognition. 98. Staff instructions for smoking dated 8-12-03, "Independent. Has own smoking materials.” 99, Observations were made of the room and contents for Resident #10 (identified by the facility as a smoker) on 8/11/03 at approximately 12:05 p.m. accompanied by a facility staff member. 100. The nightstand was observed to contain two cigarette lighters, 1 red and 1 orange. Both lighters were checked and the orange lighter was observed to produce a flame. 101. There was one full pack of cigarettes in the drawer. 102. Observations were made of the resident clothes and 2 pairs of slacks were observed to have burn holes in them. 103. Gray slacks had 4 holes and the blue slacks had | hole on left side lower leg. 104. One multiple colored plaid shirt was observed to have | hole the size of a large pencil eraser on the left side. 105. A review of the current resident care plan revealed that smoking was to be done in a safe manner and the family would provide cigarettes and lighters for the resident. 106. The facility is to keep the lighter on the nursing med cart. 107. The resident may need occasional cues to flick ash from cigarettes. 108. A review of the Pines of Sarasota Smoking Assessment for this resident revealed the resident has mild confusion and mild memory loss. 109. The resident is unable to apply his/her smoking apron. 110. The resident has a history of dropping ashes on himself/herself. 111. Under intervention the facility has stated they will store fire materials only. 112. The smoking assessment was completed on 6/13/03 per the document. 113. Anew smoking assessment was completed on 8/11/03 after surveyor intervention earlier in the day. 114. This smoking assessment stated the resident has confused/memory loss and isn't alert & orientated. "The resident has a history of burned clothing/furniture and drops ashes on self. The resident has thrown lighted tobacco products. Resident needs apron.” 115. | Written instructions for staff includes: Smokes with supervision only. Must wear smoking apron. 116. Resident # 19 was admitted on 9/28/02 with a diagnosis of cerebral vascular accident, Hemiplegia, Congested Heart Failure, and Depression. 117. On8/11/03 at 12 noon, while inspecting his clothes it was discovered he had burn holes on his pants at the zipper. 118. In an interview with the resident he stated, "That hole happened months ago. There are no holes in my other clothes.” 119. On observation it was noted that Resident # 19 had his cigarettes in the side of his wheelchair and his cigarette lighter in his shirt pocket. 120. He wheels himself out to smoke whenever he feels like smoking. 10 ‘121, His MDS dated 7/10/03, shows his cognitive skills for daily decision-making coded as a I, modified independence- some difficulty in new situations only. 122. His smoking assessment reads, alert and oriented, drops ashes on self, rare, no notation of burns but occasional burn holes in clothing. 123. Interventions read independent. 124. His care plan reads, 1. If seen smoking outside in non-designated areas redirect to smoking area outside building 5 & 7. Report any observed unsafe smoking actions such as sleeping with a cigarette lighted, dropping ash on clothing or lighting cigarette in non-smoking area. 125. Anupdated smoking assessment dated 8-12-03, revealed staff were instructed that now the resident, "must smoke with supervision only and wear a smoking apron." 126. An observation at approximately 12:45 p.m., at the entrance to the 1200 unit, at the Veranda, Resident # 31 was smoking a cigarette and talking with Resident # 19. 127. There was a small hole in the right side of his shirt and a small brown hole on the flap of his pants zipper. 128. Resident #31 was not on the list of smokers provided by the facility. 129. Interview with the staff nurse at approximately 1:40 p.m., and the Assistant Director of Nursing (ADON) on 8-11-03 at approximately 1:50 p.m., revealed they were unaware the resident was smoking cigarettes. 130. The ADON stated the resident must have been getting them from other residents. 131. Review of Resident # 31's clinical record lacked a smoking evaluation. 132. Review of the MDS revealed the resident has a cognition of - 2 -, Moderately Impaired - Decisions poor; cues/supervision required. 133. Behavioral symptoms include, Wandering and Resisting care with behaviors easily altered. 134. A smoking assessment dated 8-11-03, revealed the resident has confusion and memory loss. 135. The area on the evaluation that reads - Resident instructed and understands facility smoking 11 ' area- reads, "No." A written statement reads, "------ was not a current smoker prior to admission to Pines and did not smoke when in dementia unit. Is observed to smoke on occasion when in the company of other residents who are smoking.” 136. This resident was deemed able to smoke unattended even though his evaluation determined the resident to have confusion, memory loss and was unable to comprehend the smoking area locations. 137. At approximately 11:55 a.m., Resident # 2 was observed sitting in the hallway outside her room, in a wheelchair. 138. The pocket of her shirt contained an opened pack of cigarettes. 139. After introductions from the surveyor and the staff RN the resident was asked about smoking privileges. 140. The resident offered information regarding personal experiences with smoking. 141. She carries her own cigarettes and someone outside will give her a light. 142. She usually goes out the north exit door near the 100 Hall whenever she wants. 143. She is not aware of a specific area designated for smoking. 144. Denies any accidents with her smoking. 145. At the time of this observation the resident's hands and clothing are without signs of burns from cigarettes. 146. | With the resident's verbal permission, her personal items observed in her room showed there was an unopened pack of cigarettes in the bedside table. 147. The resident was not observed smoking a cigarette. 148. A smoking assessment completed on 6/03/03 by the facility, indicates Resident # 2 is alert and oriented, moves without assistance to designated smoking area, had no tremors of hands, has adequate vision. 149. The facility staff will store tobacco products and fire materials. 150. A review of the clinical record for Resident # 2 whose diagnoses include Convulsions, Hypertension, Depression and Right Hemiplegia, was conducted on 8/11/03 at approximately 12:10 p.m. 151. The MDS annual assessment dated 5/27/03, in section B, Cognitive Patterns, indicated the resident has Modified Independence with daily decision-making skills. 152. Section G, Physical Functioning and structural problems, indicated the resident requires physical assistance with all activities of daily living, with only set up for meals, and partial loss of range of motion in arm, hand, leg and foot, on one side. 153. A smoking assessment completed on 6/03/03 by the facility, indicates Resident # 2 is alert and oriented, moves without assistance to designated smoking area, had no tremors of hands, has adequate vision, and the facility will store tobacco products and fire materials. 154. The section relating to History of Smoking Related Incidents was blank. 155. Problems identified on the care plan dated 6/3/03, include the need for limited to maximum assist with transfers, locomotion, dressing, bathing and personal hygiene, CVA (Cerebrovascular Accident) with right-sided weakness, difficulty maintaining trunk alignment in wheelchair due to right Hemiplegia and seizure precautions. 156. After surveyor intervention, the facility completed another smoking assessment on 8/11/03. 157. The following categories were addressed: Cognition, alert and oriented with memory loss; Mobility, able to move without assistance to designated smoking area, Manual Dexterity, gross motor control, no hand tremors, and no fine motor control; Vision is adequate, Oxygen _Use, no; History of smoking related incidents, no; Assistive Devices, wheelchair. 158. The resident was instructed and understands the facility's smoking policy. 159. This was evaluated and the resident, at this time, was deemed not to be able to smoke unattended. 160. At approximately 12:15 p.m., Resident # 26 was observed sitting outside, in a wheelchair. +161. The pocket of his shirt contained an opened pack of cigarettes and a lighter. 162. After introductions from the surveyor and the staff Registered Nurse (RN), the resident was asked about smoking privileges. 163. The resident offered information regarding personal experiences with smoking. 164. He carries his own cigarettes and lighter at all times. 165. He is not aware of a specific area designated for smoking. 166. He denies any accidents with his smoking. 167. At the time of this observation his hands and clothing are without signs of burns from cigarettes. 168. With the resident's verbal permission, his personal items were observed in his room. 169. There were no observations of burns. 170. There was no storage of fire materials. 171. The resident was not observed smoking a cigarette. 172. A review of the clinical record for Resident # 26, whose diagnoses include CVA, Dementia, Hypertension, and Hemiplegia, was conducted on 8/11/03 at approximately 12:20 p.m. 173. The MDS annual assessment dated 5/20/03, in section B, Cognitive Patterns, indicated the resident is Moderately Impaired with daily decision-making skills. 174. In section E, Mood and Behavior Patterns, part 4 Behavioral Symptoms, identifies the resident as having verbally abusive behaviors that are not easily altered and socially inappropriate/disruptive behavior. 175. In section G, Physical Functioning and structural problems, indicated the resident requires physical assistance with transfers, dressing, and personal hygiene, with Partial loss of range of motion in leg and foot, on one side. 176. A smoking assessment completed on 8/19/02 and rechecked on 6/26/03, by the facility, indicates Resident # 26 is alert and oriented, moves without assistance to designated smoking area, * had no tremors of hands, had fine and gross motor control, and adequate vision. 177. There is no history of smoking related incidents. 178. The resident may smoke independently and uses a wheelchair. 179. There is no indication of instructions regarding the facility smoking policy or care planning regarding the smoking. 180. On 7/30/03, the Social Service Worker documented an encounter with the resident in which the resident, "wheeled away exhibiting what appeared to be anger." 181. This resident was documented to have thrown a lit cigarette down. 182. There is a Certification of Incapacity signed on 12/14/01 and a Health Care Surrogate identified, for Resident # 26. 183. Problems identified on the care plan dated 5/27/03, include the need for limited to extensive assist with Activities of Daily Living (ADL), related to old stroke, resident is at risk for falls secondary to limited mobility, stroke with seizure disorder, and aware of smoking policy but does not always comply and smokes in non-designated areas at times. 184. After surveyor intervention the facility completed another smoking assessment on 8/11/03. 185. The following categories were addressed: Cognition, alert and oriented with memory loss; Mobility, able to move without assistance to designated smoking area, Manual Dexterity, gross motor control, no hand tremors, and fine motor control; Vision is adequate, Oxygen Use, no; History of smoking related incidents, positive for throwing lighted tobacco products in the trash can or on the ground; Assistive Devices, wheelchair. 186. The resident was instructed and understands facility smoking policy. 187. This was evaluated and the resident was, now, deemed not able to smoke unattended. 188. Written staff instructions dated 8-12-03: Smokes with Supervision only. Must wear a smoking apron. 189. The facility constructed a screen type exterior lounge, which was tied into the host structure. - 190. It extends more than 4 feet and is constructed of wood. 191. No sprinkler protection was added. 192. Observations made during the Life Safety tour of the facility on 8/19/03 revealed in three of three designated smoking areas, the facility failed to ensure there were metal containers with self- closing lids in the designated areas. 193. Lack of appropriate receptacles can lead to ashtrays not being emptied properly and increase fire risk. 194. Review of the facility's policy and procedures for smoking revealed it had been updated on 08/03. 195. The policy and procedure outlines that each resident who smokes will be assessed for safety, and a list of smokers will be on each nursing unit. 196. The assessment will be reviewed annually or with any significant change in the resident's condition. 197. All staff is designated responsible parties in order to ensure the safety of all residents. 198. No specific provision was made as to how and when the facility staff would supervise the designated smoking areas. 199. The provided policy and procedure did not indicate specifics for staff about reporting unsafe smoking practices. 200. An interview with a Housekeeping Aide in the 1100 Hall on 8/11/03 at approximately 1:35 p.m. revealed the Aide had no knowledge of a facility smoking policy. 201. The Aide did state if a resident was found with a lighted cigarette falling or the resident was sleeping she would get a Certified Nursing Assistant (CNA) or knock the ashes off with a towel. 202. An interview with a Resident Assistant on the 100 Hall at approximately 1:45 p.m., revealed she was unaware of any policy. 203. She thought the residents could have one (1) cigarette a day and the nurse would get it for ' them. 204. An interview with a CNA on the 100 Hall at approximately 1:55 p.m., revealed he was not aware of a specific smoking policy but did know if someone on the Garden Unit wanted to smoke someone must be with him or her. 205. On 8-11-03 at approximately 3:03 p.m., the CEO, DON and facility's Nurse Consultant met with the survey team. 206. The survey team announced Immediate Jeopardy at this time. 207. Facility Administration was made aware of the extended survey, which included all resident's who smoke tobacco. 208. The survey team requested a copy of MARs, care plans and smoking assessments for all resident's who smoke. 209. The team also requested a copy of all resident face sheets and names, addresses and phone numbers of all attending physicians. 210. A facility layout was requested indicating all designated smoking area. 211. The survey team requested the number and types of smoking aprons used in the facility along with instructions for cleaning. 212. The team requested to see the incident accident log, confirmation of fire drills and staff education. 213. From approximately 4:00 p.m. until 7:00 p.m., the administrative staff returned requested documents to the survey team. 214. The facility stated there were now only 3 smoking areas. 215. The residents were being monitored on a continuous basis with staff present at all smoking areas. 216. Resident assessments would be completed by 08-12-03. 217. All resident rooms were now free from lighters except for 2 residents who were deemed - * independent smokers. 218. The facility updated the smoking policy on 8-12-03 and included a decrease of smoking areas from 8 to 3. 219. Staff education on the new policy along with a new "Resident Smoking Plan" was begun on 8-12-03. 220. The plan outlines staff responsibility including those of the laundry staff. 221. A list of residents who smoke is attached to this plan. 222. Observations from 8-12-03 through 8-14-03 revealed the dependent smokers were now being monitored at all times. 223. The facility representatives held a meeting with the residents who smoke and an agreement on fixed smoking times was reached. 224. As of 8-14-03, the residents were still allowed to smoke when they chose and staff was still monitoring. 225. After surveyor observation from 8-12-03 through 8-14-03, review of all documentation including new smoking policy and procedures, staff education, and resident assessment, the survey team removed Immediate Jeopardy on 08-14-03 prior to exit from the facility at 1:00 p.m. 226. The Agency determined that this deficient practice presented a situation in which immediate corrective action was necessary because Pines of Sarasota's noncompliance had caused, or was likely to cause, serious injury, impairment, or death to residents receiving care in the facility, affected more than a limited number of residents and cited this deficient practice as a State Class I, patterned deficiency. 227. The Agency provided Pines of Sarasota with the mandatory correction date of 08/14/03 for this deficient practice. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $12,500.00 against Pines of Sarasota, a skilled nursing facility in the State of Florida, pursuant to §§ 18 + 400.23(8)(a) and 400.102, Fla. Stat. (2003), and assess costs related to the investigation and prosecution of this case, pursuant to § 400.121(10), Fla. Stat. (2003) COUNT II 228. The Agency re-alleges and incorporates paragraphs (1) through (5) and (7) through (227) as if fully set forth herein. 229. Based upon Pines of Sarasota’s one (1) cited Class | patterned deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part Il of Florida Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Fla. Stat. (2003). WHEREFORE, the Agency intends to assign a conditional licensure status to Pines of Sarasota, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(7) commencing 08/14/03. COUNT III 230. The Agency re-alleges and incorporates paragraphs (1) through (5), (7) through (227), and (229) as if fully set forth herein. 231. Pines of Sarasota has been cited for one (1) Class I patterned deficiency and therefore is subject to a six (6) month survey cycle for a period of two years and a survey fee of $6,000 pursuant to Section 400.19(3), Florida Statutes. WHEREFORE, the Agency intends to impose a survey fee in the amount of $6,000.00 against Pines of Sarasota, a skilled nursing facility in the State of Florida, and conduct surveys every six months for two years, pursuant to § 400.19(3) (2003). 19 44 Respectfully submitted this. 9 day of February 2004. Gerald L. Pickett Fla. Bar. No. 559334 Agency for Health Care Administration §25 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. (2003), Palm Garden shall post the most 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 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 { HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail, return receipt no: 7003 1010 0003 4303 8227on February , 2004, to Nina M. Amaral, Administrator, Pines of Sarasota, 1501 N. Orange Avenue, Sarasota, Florida 34236, and U.S. Mail to John W. Overton, Registered Agent for Pies of Saraseta PY N. Ofange Avenue, Sarasota, Florida 34236. /} (Lal Copies furnished to: Nina M. Amaral John W. Overton Gerald L. Pickett, Esq. Administrator Registered Agent for Senior Attorney Pines of Sarasota Pines of Sarasota Agency for Health Care 1501 N. Orange Avenue 1501 N. Orange Avenue Administration Sarasota, Florida 34236 Sarasota, Florida 34236 525 Mirror Lake Drive, 330K (U.S. Certified Mail) (U.S. Mail) St. Petersburg, FL 33701 20

Docket for Case No: 04-001194