STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2004006481 Return Receipt Requested: v. 7003 1680 0006 9825 8953 7003 1680 0006 9825 8960 BROADWAY HOME CARE, INC. d/b/a BROADWAY HOME CARE, Respondent. ) O Y ; 2) AVS ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Broadway Home Care, Inc. d/b/a Broadway Home Care (hereinafter “Broadway Home Care”), pursuant to Chapter 400, Part III, ‘and Section 120.60, Florida Statutes, (2003), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $16,205.00 [$16,000.00 fine + $205.00 survey fee] pursuant to Sections 400.414 and 400.419, Florida Statutes for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57 Florida Statutes, Chapter 28-106, Florida Administrative Code. 3. Venue lies in Palm Beach County pursuant to Section 120.57 Florida Statutes, Rule 28-106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing assisted living facilities pursuant to Chapter 400, Part III, Florida Statutes (2003) and Chapter 58A-5 Florida Administrative Code. 5. Broadway Home Care cperates a 12-bed assisted living facility located at 3601 Broadway Avenue, West Palm Beach, Florida 33407. Broadway Home Care is licensed as an assisted living facility under license number 5763. Broadway Home Care wags 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. COUNT I BROADWAY HOME CARE FAILED TO DISCHARGE RESIDENTS WHEN THE FACILITY WAS UNABLE TO MEET THEIR NEEDS. RULE 58A-5.0181(5), FLORIDA ADMINISTRATIVE CODE (ADMISSIONS CRITERIA STANDARDS) CLASS II VIOLATION 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Broadway Home Care was cited with one (1) Class II deficiency and three (3) Class I deficiencies due to a complaint investigation conducted on June 28, 2004. 8. Based on a complaint investigation conducted on June 28, 2004 and based on record review and interview it was revealed that the facility did not ensure that residents were discharged when they no longer meet criteria for continued stay. The findings include the following: 9. Resident #1 developed Stage II and III bedsores at multiple sites on his/her body. The facility did not act to discharge this resident to a more appropriate level of care as required. The facility merely cleaned these and applied "Lanaseptic" salve and gauze coverings. The resident was not under the care of a physician or a home health agency for the bedsores. According to the facility administrator the resident had taken a significant down turn at the beginning of May and continued to worsen over the next 6 weeks until admitted to the hospital on 6/20/04 with the bedsores, dehydration and urosepsis. 10. Based on the foregoing facts, Broadway Home Care violated Rule 58A-5.0181(5), Florida Administrative Code, herein classified as a Class II violation, which warrants an assessed fine of $1,000.00. COUNT II BROADWAY HOME CARE FAILED TO ENSURE THAT THE RESIDENTS RECEIVED APPROPRIATE CARE AND SERVICES. RULE 58A-5.0182, FLORIDA ADMINISTRATIVE CODE (RESIDENT CARE STANDARDS) CLASS I VIOLATION 11. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 12. Based on a complaint investigation conducted on June 28, 2004 and based on record review and interview it was revealed that the facility did not ensure that the residents receive appropriate care and services. The findings include the following: 13. Resident #1 developed multiple bedsores on his/her body. The facility did not make any arrangements for the resident to receive appropriate care or services regarding his/her condition until it progressed to the very serious situation noted at the hospital. The facility was unable to demonstrate that it had taken any appropriate action regarding the bedsore except putting in some salve and covering them with gauge pads. Moreover, the facility failed to include any notes in the resident’s record regarding his/her condition and his/her change in condition. The facility failed to take appropriate action, such as taking the resident to the hospital, which resulted in his/her condition significantly deteriorating. At the time of admission to the hospital, the resident was also dehydrated, had a urinary infection, and was diagnosed as suffering from malnutrition. 14. According to the facility administrator, the resident had taken a significant down turn at the beginning of May and continued to worsen over the next 6 weeks until admitted to St. Mary's Hospital on 6/20/04. At the time he/she was admitted into the hospital, the resident had more than 15 bedsores in the mid- back, sacrum, buttocks, heels, ankle, and hip. The resident was also suffering from dehydration, urosepsis, and malnutrition. The bedsores were staged between Stage II and Stage III according to the nurses’ notes. 15. Based on the foregoing facts, Broadway Heme Care, Inc. violated Rule 58A-5.0182, Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $5,000.00. COUNT III BROADWAY HOME CARE FAILED TO ENSURE THAT RESIDENT’S HEALTH CARE 5 PROVIDER WAS ADVISED OF SIGNIFICANT CHANGES. RULE 58A-5.0182(1) (d), FLORIDA ADMINISTRATIVE CODE (RESIDENT CARE STANDARDS) CLASS I VIOLATION 16. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 17. Based on a complaint investigation conducted on June 28, 2004 and based on record review and interview, it was revealed that the facility did not ensure that residents’ health care providers were advised of significant changes. The findings include the following: 18. Over a_ period prior to his/her admission to the hospital, Resident #1 declined significantly and developed multiple bedsores of Stage II and Stage III levels, became unable to stand, and also became dehydrated. These changes were not brought to the attention of the resident's physician by the facility nor was the resident's case manager notified. 19. Resident #1 was admitted to St Mary's Hospital on 6/20/04 with multiple bedsores, dehydration, Urosepsis and suffering from malnutrition. Review of hospital notes and pictures taken of the resident on 06/20/04 by Adult Protective Services revealed that he/she had bedsores on the buttocks, heels, ankles, and hip. These bedsores were staged at between a Stage II and Stage IIt according to nursing notes. 6 20. The wound nurse's notes of 6/21/04 indicate that there were 15+ ulcers located on the mid-back, sacrum, scrotal distal buttocks, heels, and feet. The hospital nursing notes also indicate that the resident was dehydrated and suffering from malnourishment. 21. The facility indicated that the resident had been deteriorating since 4/30/04. According to an interview with the facility administrator on 06/28/04, although a blister was noted on his/her heel earlier, no breaks in the skin or sin breakdown were seen until approximately 3 weeks ago. The resident has been wheelchair bound for the past 3 years and was totally dependent in his/her activities of daily living. 22. The facility did not act to notify the resident's physician of the bedsores that developed and of his/her condition until it progressed to the very serious situation noted at the hospital. 23. According to the facility, the resident passed away on 6/28/04 at St. Mary's Hospital. 24. Based on the foregoing facts, Broadway Home Care, Inc. violated Rule 58A-5.0182 (1) (da), Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $10,000.00. SURVEY FEE Pursuant to Section 400.419(10), Florida statutes, AHCA may assess a survey fee of $500.00 to cover the cost of monitoring visits. A survey fee of $205.00 has been assessed in this case. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Broadway Home Care on Counts I, II and III. 2. Assess an administrative fine of $16,000.00 against Broadway Home Care on Counts I, II and III for the violations cited above. 3. Assess a survey fee of $205.00 against Broadway Home Care pursuant to Section 400.419(10), Florida Statutes. 4. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 5. 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 (2003). 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 Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (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. five, Uy.