(Certified Mail Receipt (7001 0360 0003 3804 6296) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA NO.: 2004009632 vs. 2004009437 COMMUNITY HEALTH AND a a oom REHABILITATION CENTER, INC., 0) ( [ ( | Q 2 Respondent. ee ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA’), by and through the undersigned counsel, and files this Administrative Complaint against COMMUNITY HEALTH AND REHABILITATION CENTER INC., (“Community Health and Rehabilitation Center Inc.”), pursuant to Sections 120.569, and 120.57, Fla. Stat. (2004), and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine against Community Health and Rehabilitation Center Inc., pursuant to Section 400.23(8)(c), Fla. Stat. (2004), 42 CER 483.20(k)(3)(ii), and Section 59A-4.1288, Fla. Admin. Code (2004), The Agency also intends to impose a conditional rating effective September 20, 2004, pursuant to Section 400.23(7), Fla. Stat. (2004) case no. 2004009632. JURISDICTION AND VENUE 2. This Agency has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2004). 3. Venue lies in Bay County, Panama City, Florida, pursuant to Section 120.57, Fla. Stat. (2004), and Chapter 59A-4, Fla. Admin. Code (2004). 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing skilled nursing facilities pursuant to Chapter 400, Part II, Fla. Stat. (2004), and Chapter 59A-4 Fla. Admin. Code (2004). 5. Community Health and Rehabilitation Center Inc. is a for-profit corporation, whose 120-bed nursing home is located at 3611 Transmitter Road, Panama City, Florida. Community Health and Rehabilitation Center Inc. is licensed as a skilled nursing facility license #SNF130470978; certificate number 11214, effective April 01, 2004 through March 31, 2005. Community Health and Rehabilitation Center Inc. was at all time material hereto, a licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNT I COMMUNITY HEALTH AND REHABILITATION CENTER, INC. FAILED TO FOLLOW THE CARE PLANS FOR TWO OF SIXTEEN SAMPLED RESIDENTS (#’s FEDERAL TAG £282 RESIDENT ASSESSMENT Section 42 C.F.R. 483.20(k)(3)(ii) RESIDENT ASSESSMENT Section 400.23(8)(c), Fla. Stat. (2004) RULES; EVALUATION AND DEFICIENCIES; LICENSURE STATUS Section 59A-4.1288, Fla. Stat. (2004) EXCEPTION 6. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about September 20, 2004, AHCA conducted a follow-up visit to an unannounced recertification survey at the Respondent's facility. AHCA cited the Respondent based on the findings below, to wit: a.) On or about August 12, 2004, Community Health and Rehabilitation Center, Inc. failed to follow their care plans for two (2) of twenty-five (25) sampled residents (#’s 5, 7). The findings include: Review of resident #5’s current care plan indicated they were to be turned and repositioned every two hours. Observations made of resident #5 on August 10, 2004, at 2:00 p.m., found the resident to be lying in bed with his/her eyes closed and lying on their right side. Additional observations made on August 10, 2004, at 3:00 p.m.; 4:00 pm., 5:00 p.m., and 5:50 p.m., revealed the resident still was in a right side-lying position. The resident remained in the same position until 6:02 p.m., when they were repositioned and set up to have dinner Observations made of resident $5 on August 11, 2004, at 8:00 a.m.; 8:55 p.m., 9:30 p-m., 9:45 p.m., 10:05 a.m., and 10:30 p.m., found the resident to be lying in their bed in the same position, supine and slightly on their left side. The interdisciplinary team meeting on June 10, 2004, revealed the following were to be implemented for resident #7: _ Bolsters to side-rails and float heels. An interview with the Charge Nurse was conducted on August 9, 2004, at approximately 10:00 a.m., She stated floating heels means to have heels in protectors or on a pillow. The Nurse stated the heels are not to be lying flat on the bed. She stated bolsters were long, blue pads to be placed over the side rails. The following observations were made: On August 9, 2004 ay approximately 9:40 a.m., during the initial tour, resident #7 was observed lying in the bed with % side-rails up without any pads on the side tails. The resident’s heels were lying flat on the bed without heel protectors or pillows utilized. On August 10, 2004, at approximately 2:00 p.m., the resident was observed lying in bed with the % side-rails up without the bolster pads and no heel protectors or pillows utilized. Their heels were noted to be flat on the bed. On August 10, 2004 at approximately 5:30 p.m., the resident was observed lying in the Geri-chair with socks on their heels lying flat on the footrest. On August 11, 2004 at approximately 9:15 a.m., resident #7 was observed lying in bed with the % side-rails up without bolster pads and no heel protectors or pillows utilized and both heels were observed lying flat on the bed. This surveyor asked the Charge Nurse to come into the room to acknowledge observation. She acknowledges resident #7 did not have the bolster pad on the side rails. She acknowledges resident #7’s feet no protectors on feet and was lying flat on the bed. b.) During a follow-up visit on or about September 20, 2004, Community Health and Rehabilitation Center Inc. failed to follow the care plans for two (2) of sixteen (16) sampled residents (#’s 8, 11). The findings include: Record review for resident #8’s care plan revealed to float heels. Resident #8 was observed lying in bed on September 20, 2004 at approximately 3:00 p.m., without his/her heels floated. The surveyor requested the Director of Nurses (DON) to observe resident #3 without his/her heels floated. The DON acknowledged, per interview on August 20, 2004, at 3:00 p.m., that the care plan and the resident profile were not being followed. Record review for resident #11 revealed physician orders on September 1, 2004, for hip Posey pads on when out of bed, apply seatbelt, and lap buddy while in wheelchair for safety. Resident #11 was observed at 2:30 p.m., propelling in a wheelchair without a lap buddy and without any hip Posey pads. The surveyor requested the charge nurse to observe resident #11 without his/her lap buddy and hip Posey. An interview with charge nurse was conducted on 9/20/2004 at approximately 2:30 p.m., acknowledging that neither the hip Posey nor lap buddy was in place. 8. The above constitutes a violation of 42 C.F.R. 483.20(k)(3)(Gii), requiring that the services provided or arranged by the facility must be provided by qualified persons in accordance with each resident’s written plan of care. 9. The above constitutes a violation of 400.23(7), Fla. Stat. (2004), requiring that 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 agency 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. 10. The above constitutes a violation of 400.23(8)(c), Fla. Stat. (2004), requiring that a class III deficiency is a deficiency that the agency determines will result in no more than minimal physical, mental, and 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 Il 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. jl. The above constitutes a violation of Section 59A-4.1288, Fla. Admin. Code (2004), requiring that nursing homes that participate in Title XVII1 must follow certification rules and regulations found in 42 C.F.R. 483, Requirements for Long Term Care Facilities, September 26, 1991, which incorporated by reference. Non-certified facilities must follow the contents of this rule and the standards contained in the Conditions of Participation found in 42 C.F.R 483, Requirements for Long Term Care Facilities, September 26, 1991, which is incorporated by reference with respect to social services, dental services, infection control, dietary and the therapies. 12. The violations alleged herein constitute a class II deficiency and warrant a fine of $1,000. WHEREFORE, AHCA demands the following relief: 1. Each factual and legal findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $1,000. Respondent is notified that it have a right to request an administrative hearing pursuant to 120.57, Florida Statutes (2004). 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, Tallahassee, Florida 32308; Michael Mathis, Senior Attorney. 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 IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully Submitted this BU of Defohe 2004, Leon County, Tallahassee, Florida. FIN asi eal WAN Were Michael O. Mathis Fla. Bar. No. 0325570 Counsel for Petitioner, Agency for HealthCare Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0055 (office) (850) 413-9313 (fax) Barbara Alford Agency Clerk Agency for Health Care Administration gn A A eR: CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing has been served by certified mail on ol 7 day of Let: oper, 2004 to: Carolyn Friday, Administrator, Community Health and Rehabilitation Center, Inc., 3611 Transmitter Road, Panama City, Florida 32404. Michael O. Mathis, Esq.

Docket for Case No: 04-004083