Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: WEST PALM BEACH HEALTH CARE ASSOCIATES, LLC, D/B/A AZALEA COURT
Judges: JOHN G. VAN LANINGHAM
Agency: Agency for Health Care Administration
Locations: West Palm Beach, Florida
Filed: Sep. 28, 2005
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Thursday, November 17, 2005.
Latest Update: Dec. 23, 2024
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION Dn
A heli Ue
Abi tS Ce
AGENCY FOR HEALTH CARE
ADMINISTRATION,
Petitioner, AHCA No.: 2005006183
AHCA No.: 2005006182 :
v. Return Receipt Requested:
7002 2410 0001 4234 5605
WEST PALM BEACH HEALTH CARE 7002 2410 0001 4234 5612
ASSOCIATES, LLC, d/b/a AZALEA CouRT, 7002 2410 0001 4234 5629
(OS: 38712
ADMINISTRATIVE COMPLAINT
Respondent.
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 West Pal Beach Health Care Associates, LLC, d/b/a
Azalea Court (hereinafter “Azalea Court”), 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 $5,000.00 pursuant to Section 400.23(8), Florida Statutes
(2004), for the protection of the public health, safety and
welfare.
2. This is an action to impose a Conditional Licensure
status to Azalea Court, 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 Palm Beach 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. Azalea Court is a 120-bed skilled nursing facility
located at 5065 Wallis Road, West Palm Beach, Florida 33415.
Azalea Court is licensed as a skilled nursing facility;
license number SNF1198096; certificate number 12653,
effective 06/07/2005, through 11/30/2005. Azalea Court 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.
7. Because Azalea Court participates in Title XVIIT
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.
2
COUNT I
AZALEA COURT FAILED TO ENSURE NECESSARY CARE AND SERVICES TO
ATTAIN OR MAINTAIN THE HIGHEST PHYSICAL WELL-BEING FOR ONE
OF FIVE RESIDENTS
TITLE 42, SECTION 483.13(c) (1) (i), Code of Federal
Regulations, as incorporated by Rule 59A-4.1288, Florida
Administrative Code.
(STAFF TREATMENT OF RESIDENTS)
CLASS II DEFICIENCY
8. AHCA re-alleges and incorporates paragraphs (1)
through (7) as if fully set forth herein.
9. During an abbreviated survey conducted on 6/07/05
and based on record review and interviews, it was determined
the facility did not ensure that the necessary care and
services to attain or maintain the highest physical well-
being is provided for 1 of 5 (Resident #5). The resident
did not receive hemodialysis treatments 3 times per week as
ordered on 5/16/05. The resident expired on 05/23/05.
10. Review of the resident's (Resident #5) medical
record on 06/07/05 revealed the resident was admitted to the
facility from a local hospital on May 16, 2005. The
resident's admitting diagnoses and past medical history
includes Chronic Renal Failure for 10 years, Hemodialysis 3
times weekly, Diabetes Mellitus, Hypertension, Coronary
Artery Bypass Graft and Cardiopulmonary Arrest.
11. The admitting nursing progress note dated 5/16/05
documents the resident is alert, non-verbal, and responds to
tactile stimuli only. The resident was receiving Tube feed
Renal Resource 40’ cc/hour via IV pump continuously with a
daily fluid intake of 1200 ec.
12. The resident's vital signs on admission were blood
pressure 140/90, pulse 94, respirations 20 and temperature
96.8 degrees Fahrenheit.
13. On 5/16/05 the physician ordered hemodialysis
treatment three times per week on Monday/Wednesday/Friday.
14. A care plan dated 5/17/05 documents the resident
is at risk for complications related to hemodialysis
secondary to renal failure. Complications of chronic renal
failure include fluid overload, shortness of breath,
respiratory distress and chemical imbalance due to high
levels of toxins in the blood. The planned approaches
included prepare resident for hemodialysis and coordinate
resident's care with dialysis center.
15. Another care plan dated 5/17/05 documents the
resident is at risk for respiratory distress due to a
history of cardiac arrest with diagnosis of congestive heart
failure. The care plan goals and approached includes,
"Resident will be free from signs of respiratory distress
daily till next review date 8/18/05; the resident would be
observed for signs of respiratory distress and report to
physician."
16. A nursing progress note date 5/22/05 3:45 PM
documents, "tube feeding discontinued, chest congested
noted, call DR., waiting for the call back from Doctor,
incoming nurse notified, will continue monitor and follow
plan of care."
17. According to the nursing progress note the tube
feeding was discontinued on 5/22/05 when the resident was
observed to have lung congestion.
18. The nursing progress note subsequent to the
5/22/05 3:45 PM did not address the follow up plan of care
for the resident's lung congestion and there is no
documentation to indicate the physician was notified the
resident had a change in condition on 5/22/05 at 3:45 and
the tube feeding was discontinued.
19. On 5/23/05 at 6:00AM, the nurse documents
"Resident's roommate states resident was "shaking" white
frothing liquid secretion noted on mouth."
20. On 5/23/05 at 10:28 AM, the resident was found
unresponsive in respiratory distress and had no. pulse.
Cardiopulmonary resuscitation was initiated, the resident
was pronounced dead at a local hospital on 5/23/05 at
10:52AM.
2i. Further review of the resident's medical record
revealed the medical record did not contain documentation to
substantiate the resident had received hemodialysis
treatment for the period of 5/16/05 through 5/23/05. The
resident's medical record did not contain documentation to
indicate the care plan was implemented and hemodialysis
treatment was coordinated with a dialysis facility.
22. Interview with the Director of Nursing (DON) and
Staff Development Coordinator, a Licensed Practical Nurse on
6/7/05 at 11:30AM and 2:30PM revealed on 5/16/05 a case
manager at a local hospital called the facility and informed
the admission coordinator the resident would be discharged
to the facility that day and dialysis treatment was arranged
with a local Dialysis facility. The Director of Nursing
stated, the charge nurse called the Dialysis facility on’
5/17/05 to obtain a dialysis schedule and was told they
would not accept the resident.
23. The DON and staff development coordinator stated
that the resident did not have an advanced directive in the
medical record so the resident's family was contacted
regarding hospice care. The surveyor asked if the physician
had recommended hospice care. The DON replied, "No."
24. The DON informed the surveyor she/he has reviewed
the resident's (#5) medical record and there is no
documentation to indicate the physician was notified that
the resident had not received the prescribed hemodialysis
treatment.
25. The staff development coordinator stated, it is
common facility practice for the desk nurse/charge nurse to
notify the doctor of changes, so she assumed the physician
was notified.
26. Interview conducted on 6/7/05 at 3:05PM with
Licensed Practical Nurse and charge nurse of 5/17/05,
revealed the local Dialysis facility was contacted on
5/17/05 to obtain the resident's hemodialysis schedule. A
nurse at the Dialysis facility informed him/her the dialysis
facility did not have any record of the patient and would
not accept a resident who is unresponsive. The nurse stated,
later that day (5/17/05) he/she called the resident's family
and other dialysis facilities to arrange dialysis treatment
for the resident, but they would not accept the resident
because the resident's was unresponsive and needed a
stretcher during dialysis.
27. The Licensed Practical nurse stated, he/she did
not inform the physician that the resident did not received
hemodialysis treatment.
28. The Licensed Practical Nurse stated: he/she did
not take any further action to ensure the resident received
hemodialysis treatment.
29. Interview conducted with the social worker on
6/7/05 in the afternoon revealed on 5/19/05 she/he was
informed by a nurse to contact the resident's family to
obtain consent for hospice care because the resident had not
received dialysis treatments since admission on 5/16/05. The
social worker stated, she called the resident's wife and
left a message, but the family did not contact the facility.
The social worker stated she documented this information in
the medical record on 5/20/05.
30. Interview conducted with the Administrator and
Administrative Assistant at the Dialysis on 6/8/05 at 1:20PM
revealed, the facility has no transfer record for this
resident.
31. The Administrative Assistant is responsible for
new patient medical records, he/she stated about two weeks
ago a case manager at a local hospital facility to inquire
if they would accept a patient who is unresponsive and needs
to be dialyzed on a stretcher. The case Manager was
informed; the facility could not accommodate the patient and
recommended the case manager find a nursing home with in-
house dialysis services. The administrative assistant
stated, there was no other communication with a case manager
or other staff from the local hospital.
32. Interview conducted with a case manager at the
local hospital on 6/8/05 in the afternoon revealed on
5/13/05 the Dialysis facility was contacted to arrange
dialysis for resident #5. The case Manager who made the
dialysis arrangement was not available for interview. The
case manager stated, the documentation in the hospital
computer did not indicate the medical record was sent to the
dialysis facility and the transfer arrangement was confirmed
prior ,to the patient's discharge.
33. The resident's medical record at the Skilled
Nursing Facility contains no documentation to substantiate
the physician was notified that hemodialysis treatments were
not administered to resident #5 for seven (7) days May 16-
23, 2005, as ordered. The facility did not obtain an order
to send the resident to the hospital for evaluation and
follow-up care when the dialysis treatment was not available
at a dialysis facility. The facility did not ensure the
physician was aware the resident had a change in condition
and that the tube feeding was discontinued by the nursing
staff.
34. Based on the foregoing, Azalea Court violated
Title 42, Section 483.13 (c) (1) (i), 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 II
AZALEA COURT FAILED TO ENSURE THAT A NEWLY ADMITTED RESIDENT
HAD PHYSICIAN ORDERS TO MEET THE IMMEDIATE CARE AND SERVICES
NEEDED FOR ONE RESIDENT
Section 483.20(a), Code of federal Regulations as
incorporated by Rules 59A-4.1288 and 59A-4.109(1), Florida
Administrative Code
(RESIDENT ASSESSMENT)
CLASS II DEFICIENCY
35. AHCA re-alleges and incorporates Paragraph (1)
through (7) as if set forth herein.
36. During the abbreviated survey conducted on
6/07/05 and based on record review and interviews, it was
determined that the facility did not ensure a newly admitted
resident had physician orders to meet the immediate care and
services needed for 1 of 5 sampled residents (Resident #5).
The resident did not receive hemodialysis treatments 3 times
per week as ordered on 5/16/05. The resident's physician was
not notified that the resident was not receiving
hemodialysis treatments for the period of 05/16/05 to
05/23/05. The resident expired on 5/23/05.
37. Review of the resident's (Resident #5) medical
record on 06/07/05 revealed the resident was admitted to the
facility from a local hospital on May 16, 2005. The
resident's admitting diagnoses and past medical history
includes Chronic Renal Failure for 10 years, Hemodialysis 3
times weekly, Diabetes Mellitus, Hypertension, Coronary
Artery Bypass Graft and Cardiopulmonary Arrest.
38. The admitting nursing progress note dated 5/16/05
documents the resident is alert, non-verbal, and responds to
tactile stimuli only. The resident was receiving Tube feed
10
Renal Resource 40 cc/hour via IV pump continuously with a
daily fluid intake of 1200 ec.
38. The resident's vital signs on admission were blood
pressure 140/90, pulse 94, respirations 20 and temperature
96.8 degrees Fahrenheit.
40. On 5/16/05 the physician ordered hemodialysis
treatment three times per week on Monday/Wednesday/Friday.
41. A care plan dated 5/17/05 documents the resident
is at risk for complications related to hemodialysis
secondary to renal failure. Complications of chronic renal
failure include fluid overload, shortness of breath,
respiratory distress and chemical imbalance due to high
levels of toxins in the blood. The planned approaches
included prepare resident for hemodialysis and coordinate
vesident's care with dialysis center.
42. Another care plan dated 5/17/05 documents the
resident is at risk for respiratory distress due to ‘a
history of cardiac arrest with diagnosis of congestive heart
failure. The care plan goals and approached includes,
"Resident will be free from signs of respiratory distress
daily till next review date 8/18/05; the resident would be
observed for signs of respiratory distress and report to
physician."
43. A nursing progress note date 5/22/05 3:45 PM
documents, "tube feeding discontinued, chest congested
11
noted, call DR., waiting for the call back. from Doctor,
incoming nurse notified, will continue monitor and follow
plan of care."
44. According to the nursing progress note the tube
feeding was discontinued on 5/22/05 when the resident was
observed to have lung congestion.
45. The nursing progress note subsequent to the
5/22/05 3:45 PM did not address the follow up plan of care
for the resident's lung congestion and there is no
documentation to indicate the physician was notified the
resident had a change in condition on 5/22/05 at 3:45 and
the tube feeding was discontinued.
46. On 5/23/05. at 6:00AM; the nurse documents
"Resident's roommate states resident was "shaking" white
frothing liquid secretion noted on mouth."
47. On 5/23/05 at 10:28 AM, the resident was found
unresponsive in respiratory distress and had no pulse.
Cardiopulmonary resuscitation was initiated, the resident
was pronounced dead at a local hospital on 5/23/05 at
10:52AM.
48. Further review of the resident's medical record
revealed the medical record did not contain documentation to
substantiate the resident had received hemodialysis
treatment for the period of 5/16/05 through 5/23/05. The
resident's medical record did not contain documentation to
12
indicate the care plan was implemented and hemodialysis
treatment was coordinated with a dialysis facility.
49. Interview with the Director of Nursing (DON) and
Staff Development Coordinator, a Licensed Practical Nurse on
6/7/05 at 11:30AM and 2:30PM revealed on 5/16/05 a case
manager at a local hospital called the facility and informed
the admission coordinator the resident would be discharged
to the facility that day and dialysis treatment was arranged
with a local Dialysis facility. The Director of Nursing
stated, the charge nurse called the Dialysis facility on
5/17/05 to obtain a dialysis schedule and was told they
would not accept the resident.
50. The DON and staff development coordinator stated,
the resident did not have an advanced directive in the
medical record so the resident's family was contacted
regarding hospice care. The surveyor asked if the physician
had recommended hospice care. The DON replied, "No."
51. The DON informed the surveyor she/he has reviewed
the resident's (#5) medical record and there is no
documentation to indicate the physician was notified that
the resident had not received the prescribed hemodialysis
treatment.
52. The staff development coordinator stated, it is
common facility practice for the desk nurse/charge nurse to
notify the doctor of changes, so she assumed the physician
was notified.
53. Interview conducted on 6/7/05 at 3:05PM with
Licensed Practical Nurse and charge nurse of 5/17/05,
revealed the local Dialysis facility was contacted on
5/17/05 to obtain the resident's hemodialysis schedule. A
nurse at the Dialysis facility informed him/her the dialysis
facility did not have any record of the patient and would
not accept a resident who is unresponsive. The nurse stated,
later that day (5/17/05) he/she called the resident's family
and other dialysis facilities to arrange dialysis treatment
for the resident, but they would not accept the resident
because the resident's was unresponsive and needed a
stretcher during dialysis.
54. The Licensed Practical nurse stated, he/she did
not inform the physician that the resident did not received
hemodialysis treatment.
55. The Licensed Practical Nurse stated, he/she did
not take any further action to ensure the resident received
hemodialysis treatment.
56. Interview conducted with the social worker on
6/7/05 in the afternoon revealed on 5/19/05 she/he was
informed by a nurse to contact the resident's family to
obtain consent for hospice care because the resident had not
received dialysis treatments since admission on 5/16/05. The
14
social worker stated, she called the resident's wife and
left a message, but the family did not contact the facility.
The social worker stated she documented this information in
the medical record on 5/20/05.
57. Interview conducted with the Administrator and
Administrative Assistant at the Dialysis on 6/8/05 at 1:20PM
revealed, the facility has no transfer record for this
resident.
58. The Administrative Assistant is responsible for
new patient medical records, he/she stated about two weeks
ago a case manager at a local hospital facility to inquire
if they would accept a patient who is unresponsive and needs
to be dialyzed on a stretcher. The case Manager was
informed, the facility could not accommodate the patient and
recommended the case manager find a nursing home with in-
house dialysis services. The administrative assistant
stated, there was no other communication with a case manager
or other staff from the local hospital.
59. Interview conducted with a case manager at the
local hospital on 6/8/05 in the afternoon revealed on
5/13/05 the Dialysis facility’ was contacted to arrange
dialysis for resident #5. The case manager who made the
dialysis arrangement was not available for interview. The
case manager stated, the documentation in the hospital
computer did not indicate the medical record was sent to the
dialysis facility and the transfer arrangement was confirmed
prior to the patient's discharge.
60. The resident's medical record at the Skilled
Nursing Facility contains no documentation to substantiate
the physician was notified that hemodialysis treatments were
not administered to resident #5 for seven (7) days May 16-
23, 2005, as ordered. The facility did not obtain an order
to send the resident to the hospital for evaluation and
follow-up care when the dialysis treatment was not available
at a dialysis facility. The facility did not ensure the
physician was aware the resident had a change in condition
and that the tube feeding was discontinued by the nursing
staff.
61. Based on the foregoing, Azalea Court violated
Title 42, Section 483.20(a), Code of Federal Regulations as
incorporated by Rule 59A-4.1288, and 59A-4.109(1), Florida
Administrative Code, and Sections 400.211(3), 400.215,
400.1034, and 400.147(1) (d), Florida Statutes, 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).
DISPLAY OF LICENSE
Pursuant to Section 400.23(7)(e), Florida Statutes,
Azalea Court 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
VAY"
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 and II.
B. Assess an administrative fine of $5,000.00
against Azalea Court on Counts I and II,
Cc. Assess and assign a conditional license
status to Azalea Court 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
17
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.
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.
elson E. Rodney
FL Bar No: 178081
Assistant General Counsel
Agency for Health Care
Administration
Spokane Building, Suite 103
8350 N.W. 52"? Terrace
Miami, Florida 33166
Copies furnished to:
Diane Reiland
Field Office Manager
Agency for Health Care Administration
1710 East Tiffany Drive, Suite 100
West Palm Beach, Florida 33407
(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)
EXHIBIT “A”
Conditional License
License No. SNF 1198096 Certificate No.
Effective date: 06/07/2005
Expiration date:11/30/2005
19
Docket for Case No: 05-003573
Issue Date |
Proceedings |
Jan. 18, 2006 |
Final Order filed.
|
Nov. 17, 2005 |
Order Closing File. CASE CLOSED.
|
Nov. 16, 2005 |
Motion to Relinquish Jurisdiction filed.
|
Nov. 10, 2005 |
Response to Agency`s First Request for Production filed.
|
Nov. 10, 2005 |
Response to Petitioner`s First Request for Admissions filed.
|
Nov. 10, 2005 |
Respondent`s Notice of Service of Answers to Petitioner`s First Set of Interrogatories filed.
|
Oct. 12, 2005 |
Request for Administrative Hearing filed.
|
Oct. 12, 2005 |
Notice of Agency Action filed.
|
Oct. 12, 2005 |
Notice of Referral filed.
|
Oct. 11, 2005 |
Notice of Filing Interrogatories, Admissions and Request for Production filed.
|
Oct. 04, 2005 |
Order of Pre-hearing Instructions.
|
Oct. 04, 2005 |
Notice of Hearing by Video Teleconference (video hearing set for November 21, 2005; 9:00 a.m.; West Palm Beach and Tallahassee, FL).
|
Oct. 03, 2005 |
Joint Response to Initial Order filed.
|
Sep. 29, 2005 |
Initial Order.
|
Sep. 28, 2005 |
Skilled Nursing Facility (conditional license) filed.
|
Sep. 28, 2005 |
Administrative Complaint filed.
|
Sep. 28, 2005 |
Request for Formal Administrative Hearing filed.
|
Sep. 28, 2005 |
Notice (of Agency referral) filed.
|