STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2005003557 AHCA No.: 2005003056 v. Return Receipt Requested: 7002 2410 0001 4234 3434 SOUTHPOINT HEALTH CARE ASSOCIATES, 7002 2410 0001 4234 3441 LLC, d/b/a SOUTHPOINT NURSING AND 7002 2410 0001 4234 3458 REHABILITATION CENTER, Respondent. CS > iQ oO 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 Southpoint Health Care Associates, LLC, d/b/a Southpoint Nursing and Rehabilitation Center (hereinafter “Southpoint Nursing and Rehabilitation Center”), pursuant to Chapter 400, Part II, and Section 120.60, Florida Statutes (2004), and alleges: NATURE OF THE ACTIONS 1. This is an action to impose an administrative fine of $25,000.00 pursuant to Section 400.23(8), Florida Statutes (2004), for the protection of the public health, safety and welfare, and $6,000.00 survey fee pursuant to Section 400.419(3), Florida Statutes (2004). 2. This is an action to impose a Conditional Licensure status to Southpoint Nursing and Rehabilitation Center, pursuant to Section 400.23(7) (b), Florida Statutes (2004). JURISDICTION AND VENUE 3. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2004), and Chapter 28- 106, Florida Administrative Code. 4. Venue lies in Miami-Dade County, pursuant to Section 400.121(1) (e), Florida Statutes (2004), and Rule 28-106.207, Florida Administrative Code. PARTIES 5. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing nursing homes, pursuant to Chapter 400, Part II, Florida Statutes, (2004), and Chapter 59A-4 Florida Administrative Code. 6. Southpoint Nursing and Rehabilitation Center is a 230-bed skilled nursing facility located at 42 Collins Avenue, Miami Beach, Plorida 33139. Southpoint Nursing and Rehabilitation Center is licensed as a skilled nursing facility; license number SNF1507096; certificate number 12446, effective 03/18/2005, through 06/30/2005. Southpoint Nursing and Rehabilitation Center 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. 2 7. Because Southpoint Nursing and Rehabilitation Center 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, Florida Administrative Code. COUNT T SOUTHPOINT NURSING AND REHABILITATION CENTER FAILED TO ENSURE THAT ONE OF 21 SAMPLED RESIDENTS WAS FREE FROM ABUSE AND FAILED TO FOLLOW ITS OWN POLICY AND PROCEDURE TC PROTECT THE RESIDENT FROM FURTHER ABUSE. TITLE 42, SECTION 483.13(b), Code of Federal Regulations, as incorporated by Rule 59A-4.1288, Florida Administrative Code. CLASS I DEFICIENCY 8. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 9. During the unannounced Licensure and Re- certification survey that was conducted on 3/14/05 through 3/18/05 and based on observation, record review and interview the facility failed to ensure that one of 21 sampled residents (#1) was free from abuse and failed to follow its own policy and procedure to protect the resident from further abuse. The staff member who allegedly abused the resident contributing to a fracture continued to work at the facility with easy access to the resident and other residents, for approximately three months after the alleged incident. 10. During the tour of the facility on 3/14/05 at approximately 10:00 a.m. resident #1 reported to the surveyor in the presence of the risk manager that an incident of abuse had taken place several months ago whereby the resident reported that the Certified Nursing Assistant (CNA) had grabbed him/her by the arm and swung him/her against the wall causing him/her to hit his/her head against the wall, loosing nis/her balance and falling to the floor. The fall contributed to a fracture to the resident's left elbow. Review of nursing notes dated 12/02/04 between 1:20 a.m. and 1:35 a.m. indicated that the resident complained of pain to the right leg and arm. The resident requested to be taken to the hospital. At this time, a call was placed to the physician. At 1:35 a.m. the physician called and reported that he would come in the next day for examination and ordered pain medication. However, there was no documentation that indicated that the physician (M.D.) saw the resident the following day. At 11:00 a.m. on 12/2/04 an x-ray was taken in- house. At 7:20 p.m. positive X-ray results with a fracture to the left elbow was determined. A call was placed to the M.D. At about 10:00 a.m. on 12/3/04 the resident was to be transferred to the hospital to assess the injury. Review of the discharge summary report from the hospital dated 12/3/04 revealed that the resident was admitted to the hospital for a fracture to the left elbow. The hospital performed surgery (ORIF) on the left elbow. The resident stayed in the hospital until 12/7/04. 11. Review of the Minimum Data Set dated 12/11/04 indicated that the resident is assessed as being cognitively intact in making decisions (coded a zero) and intact short and long-term memory. Review of the mood and behavior patterns section indicated that the resident was reported as being verbally abusive and resisted care. Review of the documents failed to indicate whether the facility had determined the reasons for the resident displaying such behaviors. 12. Interview with the risk manager/abuse coordinator on 3/16/05 at approximately at 11:00 a.m. revealed the CNA was suspended pending an investigation after surveyor's inquiry. The risk manager/abuse coordinator confirmed that the CNA was working in the facility from the date the alleged abuse incident took place up to the date the surveyor questioned her about the allegation. 13. Review of the Prevention and Reporting Suspected Resident Patient Abuse/Neglect and/or Misappropriation of Property does not address approaches to prevent potential abuse for residents displaying behaviors, which increases the risk of staff to resident abuse. Review of the personnel record of the CNA did not indicate that the staff was in- serviced on prevention of abuse while giving care to residents, especially to residents with behaviors. In addition, review of the CNA's personnel file did not indicate that a background screening was performed by FDLE to ensure that the staff did not have a history of abusive behavior. 14. During a second interview with the resident on 3/16/05 at about 3:20 p.m. the resident became very emotional when explaining the incident to the surveyors and stated that the CNA contributed to him/her having to wear a cast on the left elbow. The resident also indicated that he/she was afraid to stay in the facility because of the way he/she was treated in the facility. 15. The facility's lack of action for ensuring resident's safety against abuse/neglect placed this resident and other residents in an immediate jeopardy situation. 16. Based on the foregoing, Southpoint Nursing and Rehabilitation Center violated Title 42, Section 483.13(b), Code of Federal Regulations as incorporated by Rule 59A- 4.1288, Florida Administrative Code, herein classified as a Class I deficiency pursuant to Section 400.23(8) (a), Florida Statutes, which carries, in this case, an assessed fine of $10,000.00. This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). COUNT II SOUTHPOINT NURSING AND REHABILITATION CENTER FAILED TO IMPLEMENT ABUSE POLICIES AND PROCEDURES BY NOT INVESTIGATING AND REPORTING TWO INCIDENTS OF POSSIBLE ABUSE, NEGLECT AND/OR MISTREATMENT TO APPROPRIATE STATE AGENCIES AS REQUIRED FOR THREE OF TWENTY ONE SAMPLED RESIDENTS Section 483.13(c) (1) (ii), Code of federal Regulations as incorporated by Rule 59A-4, Florida Administrative Code, and Sections 400.211(3), 400.215, 400.1034, and 400.147(11) (d), Florida Statutes. (STAFF TREATMENT OF RESIDENTS) CLASS I DEFICIENCY 17. AHCA re-alleges and incorporates paragraph (1) through (7) as if set forth herein. 18. During the unannounced Licensure and Re- certification survey conducted on 3/14/05 through 3/18/05 and based on based on interviews and record review, the facility failed to implement Abuse Policies and Procedures by not investigating and reporting two incidents of possible abuse, neglect and/or mistreatment to appropriate state agencies as required for three of 21 sampled residents (R# 1, 9 and 26). 19. During the initial tour of the facility with the Risk Manager on 3/14/05 at approximately 10:00AM, resident #1, in the presence of another surveyor stated that a Certified Nursing Assistant (CNA) working on the night shift grabbed her by him/her arm, swung him/her against the wall causing him/her to hit his/her head. The resident fell to the floor, sustaining a fracture to his/her left elbow. When asked, the resident stated that this incident happened a few months ago. S/he also reported that s/he immediately reported the incident to a licensed nurse. The risk manager was asked at this time if she was familiar with the incident and what was done about it. The risk manager stated that she was familiar with the incident, however, she stated that an investigation had not been done as of yet. When asked why an investigation was not done she reported that she was not sure why but would look into it. However, the risk manager did not provide any further information to explain why an investigation was not performed. (a) Subsequent to surveyor intervention on the day of the survey of 3/14/05, the facility initiated an investigation of the allegation of abuse, suspended the CNA, and contacted Adult Protection Services. Review of the Minimum Data Set (MDS) dated 12/17/04 indicates that the resident is cognitively independent for decision-making and has intact short and long term memory of events. Further review of the resident's records from the hospital that resident was transferred to after the incident revealed that the resident was tearful and sad. An interview with the resident on 3/16/05 at about 3:20 p.m. revealed the resident felt afraid to return to the facility. (b) Interview with the Risk Manger on 3/17/05 at 4:20 p.m. revealed that she had reported to the state agency that the resident was found on the floor, however, on 3/15/05 the risk manager had reported to the state agency that the resident was allegedly abused by a CNA by being pushed against the wall leading to a fall and a fracture to the left elbow. When asked about the discrepancies between the two reports she was unable to provide an answer. (c) An attempt to interview the risk manager further on 3/17/05 at 5:18 p.m. could not be performed since the facility Director of Nursing reported that the risk manager was unavailable for questioning. The facility failed to accurately report the incident to the state agencies with two versions of the same incident, one reported in December 2004 and another in March 2005. In addition, the facility did not ensure that upon notification of alleged abuse by the resident in December 2004 that a thorough investigation was performed, with the alleged perpetrator not removed from the facility to prevent further potential abuse placing this resident and other residents in an immediate jeopardy situation. 20. A review of the admission record reveals that resident #9 was readmitted to the facility on 08/27/04, subsequent to hospitalization from 08/20/04 to 08/27/04. The clinical record reveals diagnoses of status post left hip fracture and osteoporosis among others. The clinical record also reveals that the resident has had previous right hip replacement. Review of the latest assessment dated 03/01/05 in the clinical record reveals that resident #9 is cognitively intact. Further review indicates that the resident requires limited assistance for mobility and is dependent on staff for cransfers. (a) Review of the nurses' notes dated 08/08/04 has a 9:15 pm entry, which stated: Heard a noise, resident noted on the floor. The resident was lying on the left side. The resident was unable to explain what happened. With help, he/she was put back to bed. The resident, still uncooperative, refuse to stay in bed or sit in chair. Assess the resident zero injury noted at this time. An attempt was made calling MD at 9:30 pm (name given), no answering service was available. The office will be open on Monday at 8:00 am. On 08/09/04, at 12:00 midnight, the entry stated that the resident was in bed, no discomfort noted. At 5:00 am, the entry stated out of bed with difficulty. At 6:30 am, the entry stated, Resident can barely move the left leg, uncooperative. A call was placed to the doctor at 6:50 am and an X-ray was ordered at 7:10 am. On in the clinical record state that the resident complained of pain to the right hip, an x-ray of the hip was ordered. On 08/10/05, the 1:00 pm nursing entry states X-ray left hip down to ankle negative. Review of a portable right hip x-ray dated 08/09/04 revealed that the resident has a "left femoral neck fracture, indeterminate age, though it does not appear acute. Under the "Portable Hip" section of the X-Ray report, it stated, "the appearance is not suggestive of any acute fracture. This seems sub acute as shown. Correlate further history and physical examination findings." The physician was called about the x-ray findings at 8:am and a fax was sent to the MD office at that time. Another call was placed to the MD office at 11:00 am, but the call was not returned. The note also stated that the resident was ambulating without difficulty. On 08/13/04 at 1:00 pm, the resident was moving his/her extremities upon commands. On 08/16/04, the 11:00 am entry noted that the resident was given Tylenol for pain. On 08/20/04, the 9:30 nursing entry is as stated, resident out of bed to wheel chair AAOx3 (alert and oriented times three). No complaint of pain vital signs within normal limits...Recall MD (name given) regarding pt's (patient's) difficulty in mobility due to left hip fx (fracture). A complete assessment was done. Ecchymotic area noted to left hip. Patient denies any pain at site. Bruises noted to left lower leg. MD (name given) returned call. A new order was given to transfer resident to hospital (name given) for further evaluation of left hip fracture. A review of the hospital medical records, which was obtained on 03/17/05, shows that the resident underwent surgery for a left hip hemiarthroplasty on 08/22/04. (b) The Director of Nursing (DON) and the Risk Manager (RM) were interviewed on 03/16/05 at 9:22am. The DON was asked if this resident's fall was investigated for potential abuse or neglect, she stated that it was not. The DON stated that since the fracture was not acute, there was no need for an investigation. On 03/17/05 at approximately 6:22 H pm, the DON was asked once again about the resident's injury. The DON stated that per the mobile X-ray, the resident did not have an acute fracture. She stated that when the resident complained of pain, the resident was sent to the hospital for evaluation of the x-ray. She stated that when the resident left the facility, he/she did not have an acute fracture. The DON further stated that there was no way for the facility to determine that this resident had a fracture. He/she said that given the resident's diagnosis, it could have happened at the hospital. When asked about the possibility of the injury happening at the facility, since the resident had a previous x-ray of the hip at the hospital in 05/05 which was not indicative of a left hip fracture, the DON stated, "I will not own this fracture". The DON was asked if Adult Protective Services had not been notified, he/she stated that there was no need to do so. 21. Review of resident #26’s clinical record revealed a nursing note dated 9/6/04 at 7:25 p.m. that the resident was observed to have a right leg trauma. The note further reported that the resident was assisted into bed by staff, alert but not able to give account of injury. A call was placed to the physician. The physician called at 8:00 p.m. and the resident was transferred to the Emergency Room (ER). (a) An interview with the Director of Nursing (DON), Administrator, and corporate nurse on 3/17/05 at 6:00 p-m. was conducted to obtain more information about the incident. The DON reported that the resident had twisted his/her knee in the bus in rout to the facility, with a swollen leg and was send to the hospital with a fracture. The clinical record did not have a copy of the x-ray reports. The DON reported that she was basing her information on her recollection of what took place. There was no documentation provided to indicate the facility investigated the injury to rule out potential abuse/neglect. The DON reported that the resident was returning back to facility after being transferred to another nursing home due to _ hurricane evacuation. The facility staff had assisted the residents with placing the resident on the bus for the return back to the facility on 9/6/04. When asked if Adult Protective Services was contacted, the DON stated that she did not know but would provide further information. However, three attempts (3/17/05 at 6:00 p.m., 3/18/05 at 9:30 a.m. and 10:45 p.m.) were made to obtain information about the incident, however, the facility did not provide any information. On 3/18/05 at 11:45 a.m. the DON reported that no report could be found concerning the incident. (b) The facility did not demonstrate that injuries of unknown origin that may have resulted from potential abuse/neglect were thoroughly investigated in order to prevent further potential abuse/neglect. 22. Based on the foregoing, Southpoint Nursing and Rehabilitation Center violated Title 42, Section 483.13(c) (1) (ii), Code of Federal Regulations as incorporated by Rule 59A-4.1288, Florida Administrative Code, and Sections 400.211(3), 400.215, 400.1034, and 400.147(1) (d), Florida Statutes, herein classified as a Class I deficiency pursuant to Section 400.23(8) (a), Florida Statutes, which carries, in this case, an assessed fine of $10,000.00. This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). COUNT III SOUTHPOINT NURSING AND REHABILITATION CENTER FAILED TO PREVENT HARM BY NOT PROVIDING PROMPT CARE AND SERVICES AFTER A RESIDENT SUSTAINED A FALL AT THE FACILITY FOR ONE OF TWENTY ONE SAMPLE RESIDENTS Section 483.25, Code of Federal Regulations, as incorporated by Rule 59A.4, Florida Administrative Code (QUALITY OF CARE) CLASS II DEFICIENCY 23. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 24. During an unannounced Licensure and Re-certification survey conducted on 3/14/05 through 3/18/05 and based on clinical record review and facility staff interview the facility failed to prevent harm by not providing prompt care and services after a resident sustained a fall at the facility for one of 21 sampled residents, (R #9). An X-Ray revealed 14 that the resident had a fractured hip that required immediate hospitalization and surgical intervention. 25. The clinical records for resident #9 reveals diagnoses of osteoporosis and status post left hip fracture among others. A further review of the clinical record reveals that the resident has a past surgical history for right hip replacement. The resident's most recent Minimum Data Set (MDS), which was completed on 03/01/05 shows that the resident is cognitively intact with no long term or short term memory deficits. The MDS also shows that resident #9 requires physical assistance with transfers, and is dependant on staff for assistance. A review of the facility's face sheet reveals that this resident was initially admitted to the facility on 05/25/02 and was subsequently readmitted on 08/27/04, post hospitalization and surgery for a left hip hemiarthroplasty. (a) A review of the clinical record reveals the following nursing entries. On 08/08/04, the 9:15 pm entry states: "Heard a noise resident noted on the floor. The resident was lying on the left side unable to explain what happened. With help, he/she was put back to bed. Still uncooperative, the patient refused to stay in bed or sit in chair. Assesses the resident zero injury noted at this time." An attempt was made to call the MD (name given) at 9:30 pm but the answering service was not available. At 5:00 am, the entry states “out of bed with difficulty." At 6:30 am, the 15 entry states, "Resident can barely move the left leg, uncooperative." There is no indication in the nursing entries prior to the fall of 08/08/04 that would suggest that this resident was having difficulty with his/her mobility. A call was placed to the doctor at 6:50 am and an X-ray was ordered at 7:10 am. On in the clinical record state that the resident complained of pain to the right hip, an x-ray of the hip was ordered. There is no record in the nursing notes of any medications or interventions that was given to the resident to alleviate his/her pain. On 08/10/05, the 1:00 pm nursing entry states "X-ray left hip down to ankle negative." This statement is inconsistent with the review of the portable right hip x-ray report dated 08/09/04 which reveals that the resident has a "left femoral neck fracture, indeterminate age, though it does not appear acute." Under the "Portable Hip" section of the X-Ray report, it states, "The appearance is not suggestive of any acute fracture. This seems sub-acute as shown. Correlate further history and physical examination findings. There is no statement on the report, which states that the study was negative. (b) There is no notation of pain or discomfort until the 11:00 am nursing entry dated 08/16/04, which states that the resident was receiving Tylenol for pain. There is no further comment that would indicate a pain site, pain origin and level of pain. On 08/20/04, the 9:30 nursing entry is as stated, "resident out of bed to wheel chair AAOx3 (alert and oriented times three). No complaint of pain, vital signs within normal limits. The next sentence then reads, "recalled MD (name given) regarding pt's (patient's) difficulty in mobility due to left hip fx (fracture). A complete assessment was done. Ecchymotic area noted to left hip. Pt denies any pain at site. Bruises noted to left lower leg. MD (name given) returned call." A new physician order was given for the resident to be transferred to the hospital. A review of the resident's medical records, which was obtained from _ the hospital on 03/17/05, shows that the resident underwent surgery for a left hip hemiarthroplasty on 08/22/04 due to sustaining a fracture. (c) A request was made to interview the Director of Nursing (DON) and the Risk Manager (RM) on 03/16/05 at 5:18 pm about the fall. The DON informed the survey team that the RM was too traumatized to speak with the team. At approximately 6:22 pm, the DON was questioned about the resident's injury. The DON stated that per the mobile X-ray, the resident did not have an acute fracture. However, the portable right hip x-ray report dated 08/09/04 reveals that the resident did have a left femoral neck fracture. She stated that when the resident complained of pain, the resident was sent to the hospital for evaluation of the x-ray. The DON further stated that there was no way for the facility to determine that this resident had a fracture. He/she said that given the resident's diagnosis, it could have happened at the hospital. When asked about the possibility of the injury happening at the facility, since the resident had a previous x-ray of the hip at the hospital in 05/05 which was not indicative of a left hip fracture, the DON stated, "I will not own this fracture." (ad) The facility did not properly assess the extent of the resident's injury and did not take appropriate and timely steps to prevent further injury for twelve days although the X-ray result determined that a fracture existed. Twelve days later, only after the resident's mobility deteriorated, the resident was sent to the hospital for further evaluation of the fracture. The resident was subsequently hospitalized and a left hemi-arthroplasty (hip replacement) surgical procedure was performed. 26. Based on the foregoing, Southpoint Nursing and Rehabilitation Center violated Title 42, Section 483.25, Code of Federal Regulations as incorporated by Rule 59A-4.1288, Florida Administrative Code, herein classified as a Class II deficiency pursuant to Section 400.23(8) (b), Florida Statutes, which carries, in this case, an assessed fine of $2,500.00. This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). COUNT IV SOUTHPOINT NURSING AND REHABILITATION CENTER FAILED TO PROPERLY ASSESS, IMPLEMENT AND EVALUATE CARE IN ORDER TO 18 PREVENT THE DEVELOPMENT OF PRESSURE SORES FOR ONE OUT OF TENT SAMPLED RESIDENTS, WHICH LED TO ACTUAL HARM Section 483,25(c), Code of Federal Regulations, as incorporated by Rule 59A-4, Florida Administrative Code (QUALITY OF CARE) CLASS II DEFICIENCY 27. AHCA re-alleges and incorporates paragraphs (1) through (7) as if fully set forth herein. 28. During an unannounced survey conducted from 3/14/05 through 3/198/05 and based on observation, interview and record review the facility failed to properly assess, implement and evaluate care in order to prevent’ the development of pressure sores for one (1) out of ten (10) sampled residents, #6 which led to actual harm. 29. Review of the clinical record for resident #6 reveals that the resident was admitted to the facility with the diagnosis of Alzheimer's, senile dementia, psychosis, and decubitus ulcers among others. Review of the Minimum Data Set (MDS) dated 2/11/05 in the clinical record indicates that the resident never/rarely makes decisions and has leng and short- term memory problems. The MDS further indicates that the resident is dependent on staff for transfers, dressing, eating, hygiene and bathing. The MDS also indicates that the resident has partial loss of her/his arm on one side, bilateral partial loss of her/his hands and legs, and bilateral full loss of her/his feet. (a) Continued review of the MDS reveals that the resident uses a splint or brace for more than fifteen minutes per day. Review of the clinical record indicates that the resident has an Interdisciplinary Therapy Screening dated 2/4/05 that states that the resident is on hospice and no occupational therapy services are warranted at this time. The resident can benefit from a hand roll to prevent further skin breakdown. Further review of the clinical record reveals a physician order dated 2/4/05 which states: hand roll to left hand at all times except bathing and range of motion. Another physician order dated 2/4/05 states Restorative Nursing Program for splint check to prevent skin breakdown start 2/7/05 and stop 4/7/05. (b) Review of the nursing wound care notes at the time of admission at 11:00AM reveals that the resident has stage II decubitus ulcers to the sacrum, right foot and right hallux. Further review of the clinical record reveals a Braden Scale for Predicting Pressure Sore Risk dated 2/2/05. The form indicates that the resident's score of 7 places her/him at severe risk for developing a pressure ulcer. Continued review of the nurses' notes dated 3/7/05 at 4:30PM reveals that wound care assessment done, noted left hand with stage II pressure ulcer, treatment was administered. (c) During observation of the resident on 3/14/05 at 3:10PM a hand roll was lying on the resident's bedside 20 table and one splint was lying next to the resident's hand in the bed. There was nothing on or in the resident's hands. On 3/15/05 at 12:35PM and again at 3:10PM the resident was observed with no hand rolls or splints. (d) Interview with the Wound Care Nurse on 3/16/05 at 1:40PM, she stated that the resident got the wound to her/his left hand because the resident's fingers were pressing into the hand secondary to their hand contractures. During an interview with a Restorative aid at approximately 1:45PM, she stated that the restorative aid along with the Certified Nursing Assistants (CNA) is to ensure that the resident's splints are used as ordered. She further stated that they receive a list of residents, which is updated monthly, from the therapy department indicating residents with splints. The Director of Nurses' was informed of this finding on 3/17/05 at 11:00AM. She confirmed that the resident was not admitted with the wound to the left hand. She further stated that the Restorative staff was to document on the "Restorative Care Flow Record" under the heading "splints/cones/braces" that the resident's splints were used. Review of the record for the month of February 2005 with the DON indicates that the form is not filled out in this area. There are no documentations that indicate that the resident's splints were used as ordered to aid in the prevention of skin breakdown. 21 {e) Facility's failure to provide appropriate wound care interventions led to development of pressure sores and actual harm. 30. Based on the foregoing, Southpoint Nursing and Rehabilitation Center violated Title 42, Section 483.25(c), Code of Federal Regulations as incorporated by Rule 59A- 4.1288, Florida Administrative Code, herein classified as a Class II deficiency pursuant to Section 400.23(8) (b), Florida Statutes, which carries, in this case, an assessed fine of $2,500.00. This violation also gives rise to a conditional licensure status pursuant to Section 400.23(7) (b). COUNT V ADDITIONAL FINE UNDER SECTION 400.19(3), Florida Statutes 31. The Agency, in addition to any administrative fines imposed, may assess a survey fee. The fine for the 2-year period shall be $6,000.00, one half to be paid at the completion of each survey. DISPLAY OF LICENSE Pursuant to Section 400.23(7) (e), Florida Statutes, Southpoint Nursing and Rehabilitation Center shall post the 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. The Conditional License is attached hereto as Exhibit “A” 22 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 through v. B. Assess an administrative fine of $25,000.00 against Southpoint Nursing and Rehabilitation Center on Counts I through IV, and assess a $6,000.00 survey fee pursuant to Section 400.19(3), Florida Statutes on Count V. c. Assess and assign a conditional license status to Southpoint Nursing and Rehabilitation Center 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 (2004). 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 Administration, Agency Clerk, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, telephone (850) 922- 5873. 23 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. (lib ( ia € FL Bar No: 178081 Assistant General Counsel Agency for Health Care Administration Spokane Building, Suite 103 8350 N.W. 52°? Terrace Miami, Copies furnished to: Diane Lopez Castillo Field Office Manager Agency for Health Care Administration Manchester Building 8355 N.W. 53°? Street Miami, Florida 33166 (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) 24 Florida 33166 EXHIBIT “A” Conditional License License No. SNF 1507096 Certificate No. Effective date: 03/18/2005 Expiration date: 06/30/2005 25 12446

Docket for Case No: 05-002102