STATE OF FLORIDA pn AGENCY FOR HEALTH CARE IDA NISTRATION Peed ™ - | 04 SEP 2) py peje AGENCY FOR HEALTH CARE ; . Wu ys ADMINISTRATION, \ Ae DIVISe. ‘ AUMIN) - Petitioner, HES bes vs. Case No. 2004005417 2004005418 DELTA HEALTH GROUP, INC., d/b/a , RIVERCHASE CARE CENTER 0) op NURSING HOME Y 22’ ¢ 47 The Respondent. 7 / _ ADMINISTRATIVE COMPLAINT ALTH CARE ADMINISTRATION COMES NOW the AGENCY FOR HE. CAHCA”), by and through the undersigned counsel, and files this Administrative ‘Complaint against RIVERCHASE CARE CENTER, (“Respondent”), pursuant to ‘Section 120.569, and 120.57, F lorida Statutes, (2003), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $3,000.00 against Respondent, pursuant to Section 400.102, Florida Statutes, (2003) and assign a “conditional license”, as provided by Section 400.23(7), Florida Statutes (2003). The original conditional license certificate is attached hereto as Exhibit “A”. 2. Count I of this action [AHCA No. 2004005417], is agency action, pursuant to Section 400.102(1)(d) and 400.23(8)(b), Florida Statutes (2003), to impose an administrative fine upon the facility in the amount of $3,000.00 for a Class II deficiency. The deficiency finding relates to the facility’s alleged failure to comply with or document the employee in-service training requirements of subsection 400.211(4), Florida Statutes. - Count II of this action [AHCA No. 2004005418] consists of agency action to assign a conditional rating licensure status upon the Respondent’s licensure based upon the presence of the Class III deficiency. JURISDICTION AND VENUE 3. The Agency (AHCA) has jurisdiction over the Respondent pursuant to Sections 120.569 and 120.57, Florida Statutes (2003). 4. Venue shall be determined pursuant to Rule 28- 106.207, Florida Administrative Code (2003). " PARTIES 5. Pursuant to Chapter 400, Part I (sections 400.011 through 400.334, Florida Statutes (2003), AHCA is the licensing and enforcing authority with regard to nursing home facility laws and state administrative rules adopted within Chapter 59A-4, Florida Administrative Code (2003). AHCA also. has the legal authority to enforce applicable federal regulations (Code of Federal Regulations), governing nursing home facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended). 6. Respondent, doing business as Riverchase Care Center, is a Florida corporation with a principal address of 2 North Palafox Street, Pensacola, FL 32502. 7. Respondent operates a 120-bed skilled nursing facility located at 1017 Strong Road, Quincy, FL 32351. Respondent holds skilled nursing facility license #SNF 1477096, effective December 2, 2003, through December 31, 2004. At all relevant times, Respondent was a licensed facility required to comply with all applicable regulations, state and federal statutes and rules under the licensing authority of AHCA. COUNT I RESPONDENT FAILED TO ENSURE AND DOCUMENT THAT CNA as } EMPLOYEES RECEIVED INSERVICE TRAINING : Oz Me 1 . 1 Ko Sections 400.102(1)(d), 400.022(1)(), 400.211(4), Ane, °, ‘ 400.23(7) and (8), Florida Statutes (2003) Ay MKS AED AL oo Rules 59A-4.106(4)(f) and (5), F.A.C. (2003) g.' AHCAte-alleges and incorporates paragraph numbers (1) through (7) as if fully set forth herein. 9. AHCA conducted an annual survey of Respondent on or about April 15, 2004. Investigation revealed the following Class III deficiency: failed to ensure that 6.of 6 Based on record review and staff interview, the facility 8, 9 and 10, had verification of 18 certified nursing assistants (CNA), employees #5, 6, 7, hours of in-service training per year. ; Findings include: ' ‘A review of facility employee records was conducted on 4/15/04 at approximately 9:00 AM. The review revealed that the records for employees #5, 6,:7, 8, 9 and 10 had documents that showed the dates of their on-going in-services but there were no time ‘limits for the in-services on these documents. aff development director was conducted on 4/15/04 at nterview and a subsequent search of facility records determine how long these in-services lasted and ether the above employees had received. the required 18 An interview with the facility st approximately 10:00 AM. The i revealed that there was no way to therefore no way to determine wh hours of in-service training per year. 10. Section 400.21 1(4), Florida Statutes (2003), provides: me facility for a 12-month period or shall submit to a performance review ducation based on the outcome of s. 400.211(4) When employed by a nursing ho} longer, a nursing assistant, to maintain certification, every 12 months and must receive regular in-service e such reviews. The in-service training must: (a) Be sufficient to ensure the continuing competence of nursing assistarits, must be at least 18 hours per year, and may include hours accrued under s. 464.203(8); (b) Include, at a minimum: , 1. Techniques for assisting with eating and proper feeding; 2. Principles of adequate nutrition and hydration; 3. Techniques for assisting and responding to the cognitively impaired resident or the resident with difficult behaviors; 4. Techniques for caring for the resident at the end-of-life; and 5. Recognizing changes that place a resident at risk for pressure ulcers and falls; and (c) Address areas of weakness as determined in nursing assistant performance reviews and may address the special needs of residents as determined by the nursing home facility staff. 11. Pursuant to subsection 400.23 (8)(c), F.S., AHCA provided the Respondent a mandated correction date of May 15, 2004, for this class III deficiency. 12. ' AHCA conducted a follow-up survey of Respondent on or about May 20, 2004. Investigation revealed the Respondent continued to fail to substantiate the in- service training of CNA employees, contrary to law. The findings of that survey are: the facility failed to ensure that 10 of 10 sampled Based on interview and record review, had documentation that they received the employees employed 12 months or longer, required 18 hours of inservice on an annual basis. Findings include: A review of the personnel records for employees #5, 6, 7, 9, 10, 11, 12, 15, 16 and 17 were reviewed on 5/20/04. The review revealed that all 10 of the employees had documentation of some of the required training, but none of the employees had documentation for more than 7 hours of inservice on an annual basis. terview with the facility's personnel administrator was conducted on 5/20/04 at 3:00 PM. The interview revealed that the facility was unable to prove that any of the above employees had received the required 18 hours of inservice training, and that they could not prove that they had a plan in place to ensure that these and other employees receive the required 18 hours of inservice training on an annual basis. Anin 13. Further, Rules 59A-4.106(4)(f) and (5), Florida Administrative Code, establish directives for the Respondent to establish policies and procedures for staff via i} education. | : \ i | 14. Based on the foregoing, there exist grounds under subsection 400.102(d), ES., for agency action. 15. Section 400.23(8), Florida Statutes (2003), provides: s. 400.23 Rules, evaluation and deficiencies; licensure status. (8) The agency shall adopt rules to provide ‘that, when the criteria established under subsection (2) are not met, such deficiencies shall be classified according to the nature and the scope of the deficiency. The scope shallbe-cited as isolated, patterned, or widespread. An isolated deficiency is a deficiency affecting one or a very limited number of residents, or involving one or a very limited number of staff, or a situation that occurred only occasionally or in a very limited number of locations. A patterned deficiency is a deficiency where more than a very limited number of residents are affected, or more than a very limited number of staff are involved, or the situation has occurred in several locations, or the same resident or residents have been affected by repeated occurrences of the same deficient practice but the effect of the deficient practice is not found to be pervasive throughout the facility. A widespread deficiency is a deficiency in which the problems causing the deficiency are pervasive in the facility or represent systemic failure that has affected or has the potential to affect a large portion of the facility’s residents. ,The agency shall indicate the classification on the face of the notice of the deficiencies as follows: (c) A class II deficiency is a deficiency that the agency determines will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the resident's ability to maintain or reach his or her highest practical physical, mental, or psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class III deficiency is subject to a civil penalty of $1,000 for an isolated deficiency, $2,000 for a patterned deficiency, and $3,000 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 citation for a class III deficiency must specify the time within which the deficiency is required to be corrected. If a class II deficiency is corrected within the time specified, no civil penalty shall be imposed. 16. Pursuant to subsections 400.102(1)(d) and 400,23(8)(c), Florida Statutes (2003), the Agency is authorized to impose a fine in the amount of three thousand dollars’ ($3,000.00), for this wide-spread Class Ill deficiency violation which affected all CNA employees of the Respondent and which was not corrected during the time specified in the first survey. WHEREFORE, AHCA intends to impose an administrative fine in the amount of $3,000.00 against the Respondent, a skilled nursing facility in the State of Florida, \ pursuant to Section 400.102, Fla. Stat. (2003) n 4 COUNT II ASSIGNMENT OF CONDITIONAL LICENSURE STATUS: RESPONDENT WAS NOT IN SUBST: ANTIAL COMPLIANCE RESULTING IN THE CITATION OF AN WIDESPREAD “CLASS IIT” DEFICIENCY AGAINST THE FACILITY §400.23(7)(b) and (8), Florida Statutes (2003) 17. The Agency realleges and incorporates by reference paragraphs one qd) through sixteen (16) above as if fully set forth herein. 18. The statutory provisions relevant to the imposition of .‘conditional” licensure status sought in Count I are contained in Section 400.23(7)(b), Florida Statutes (2003), which provides: 400.23 Rules, evaluation and deficiencies; licensure status. — (7) The agency shall, at least every 15 months, evaluate all nursing home facilities and make a determination as to the degree of compliance by each licensee with the established rules adopted under this part as a basis for assigning a licensure status to that facility. The agericy shall base its evaluation on the most recent inspection report, taking into consideration findings from other official reports, surveys, interviews, investigations, and inspections. .The agency shall assign a licensure status of standard or conditional to each nursing home. (b) A conditional licensure status means that a facility, due to the presence of one or more class I or class II deficiencies, or class III deficiencies not corrected within the time established by the agency, is not in substantial compliance at the time of the survey with criteria established under this part or with rules adopted by the agency. If the facility has no class J, class II or class IIT deficiencies at the time of the follow-up survey, a standard licensure status may be assigned. — 19. | The Respondent’s conduct, actions and inaction in this matter establish 1 both: : (a) the presence at the time of the subject survey of a violation by the Respondent of Section 400.211(4), F.S., by its failure to ensure CNA employees ’ receive required in-service training; and (b) that this thus-proven violation is a Class I violation that is “widespread” in scope, as defined by Florida law. 20. By statutory definition, the Respondent thus was not in substantial compliance with the criteria (regulations) pertaining to nursing homes on April 15, 2004. AHCA hereby assigns the conditional licensure status to the Respondent, effective April 15 , 2004, pursuant to subsection 400.23(7)(b), Florida Statutes (2003). . | WHEREFORE, AHCA requests this Court order the following relief: ‘ A. Make factual and legal findings in favor of AHCA on Count I. B. Uphold the assignment of the conditional licensure status imposed upon Respondent effective April 15, 2004, as reflected on the license attached hereto as Exhibit “A”. , NOTICE Respondent is 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 Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tullahassee, Florida, 32368; Attention: Clerk of Agency Proceedings. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED AGENCY. Respectfully; submitted on this / / day of August 2004. NADIA. f Robert F! Langford, Jr. Assistant General Cou Agency for Health Care Administration 2727 Mahan Drive IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE , Bldg. 3, MSC#3 Tallahassee, FL 32308 (850) 922-5873 (office) (850) 413-9313 (fax) 1 CERTIFICATE OF SERVICE I HEREBY CERTIFY that true and correct copies of the foregoing has been served by certified mail on this YA ¢ day of Ages s/ 2004 to Linda J. Blackshear, Administrator, Riverchase Care Center, 1017 Strong Road, Quincy, FL 32351 and Sondra McCrory, Registered Agent, Delta Health Group, 2 North Palafox Street, Pensacola, FL 32501.

Docket for Case No: 04-003376