LEG By STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 97 AUG 15 P¥ 3:37 STATE OF FLORIDA, DIVISION GF AGENCY FOR HEALTH CARE . ADIN IS IRATIVE ADMINISTRATION, b T-DL40 RINGS Petitioner, vs. Case Nos. (Fines) 2007007080 (Conditional) 2007007082 GUARDIAN CARE, INC. d/b/a GUARDIAN CARE NURSING & REHABILITATION CENTER, Respondent. / ADMINISTRATIVE COMPLAINT. COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter “Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Guardian Care, Inc. Vb/a Guardian Care Nursing & Rehabilitation Center (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2006), and alleges: | NATURE OF THE ACTION This is an action against a skilled nursing facility to impose an administrative fine of five thousand dollars ($5,000.00) and to assign conditional licensure status beginning on May 17, 2007, and ending on June 27, 2007, based upon. one class I] deficiency. <~* . JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2006). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, and Chapters 408, Part II, and 400, Part II, Florida Statutes (2006). EXHIBIT Pop 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the licensing and regulatory authority that oversees skilled nursing facilities in Florida and enforces the applicable federal and state statutes, regulations and rules, governing such facilities. Chs. 408, Part II, and 400, Part II, Fla. Stat. (2006); Ch. 59A-4, Fla. . Admin. Code. The Agency may deny, suspend, or revoke a license issued to a skilled nursing facility, and impose administrative fines pursuant to Sections 400.121, 400.23, 408.813 and 408.815, Florida Statutes (2006); assign conditional licensure status pursuant to Subsection 400.23(7), Florida Statutes (2006); and assess costs related to the investigation and prosecution of this case pursuant to Section 400.121, Florida Statutes (2006). 5, The Respondent was issued a license by the Agency (License No. 1186096) to operate a 120-bed skilled nursing facility located at 2500 West Church Street, Orlando, Florida 32805, and was at all times material times required to comply with the applicable federal and state regulations, statutes and rules. _ COUNTI : The Respondent Committed An Intentional Or Negligent Act Affecting The Health or Safety Of Its Residents In Violation Of F.S. 400.102(1)(a) 6. The Agency re-alleges and incorporates paragraphs 1 through 5. Fe. ‘Under Florida Jaw, an intentional or negligent act materially affecting the health or safety of residents of the facility shall be grounds for action by the agency against a licensee. § 400.102(1)(a), Florida Statutes (2006). 8. Under Florida law, all licensees of nursing home facilities shall adopt and make public a statement of the rights and responsibilities of the residents of such facilities and shall treat such residents in accordance with the provisions of that statement. The statement shall assure each resident the following...the right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if available; planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan...the right to be free from mental and physical abuse, corporal punishment, extended involuntary seclusion, and from physical and chemical restraints... § 400.022, Florida Statutes (2006). , 9. Under Florida’s common law, residents of a nursing home facility are entitled to care, treatment and services in accordance with the prevailing standard of care. 10. On or about May 14-17, 2007, the Agency conducted an annual licensure survey of the Respondent and its Facility. 11. Based on observation, interview and record review, the Respondent failed to ensure that 1 of 21 sampled residents was free from pain and discomfort during wound care treatment (Resident #3). 12. A review of the clinical records of Resident #3 revealed that the Resident was readmitted to the Facility from the hospital with diagnoses of renal failure, peripheral vascular disease, thyroid mass, arthritis, hypertension, congestive heart failure, decubitus ulcers on the left and right heels and coccyx and a non-healing right knee ulcer. 13. The Resident was referred to hospice care for care and comfort and was. admitted to its services on April 23, 2007. 14. On May 14, 2007, at approximately 9:30 a.m., the Resident was observed to be in bed and awake, but unresponsive to verbal communication. 15. The Resident was totally dependent on staff for all activities of daily living. 16. The Resident had contractures of both hands, a gastrostomy tube for feeding and a Foley urinary catheter. 17. The Resident had stage III and IV pressure ulcers on the left and right heels and a stage IV pressure ulcer on the coccyx area. . 18. During an observation of wound care on May 15, 2007, at approximately 10:25 a.m., by the wound care nurse, the Resident was groaning and moaning in pain. 19. | When the nurse removed the soiled dressings from both heels, the Resident groaned and tried to pull away. 20. The wounds had a foul odor with a large amount of sero-purulent (bloody white- yellow) discharge. 21. The last pressure ulcer measurements that were obtained by the nurse were dated May 9, 2007. 22. The pressure ulcer on the left heel measured 8 cm. by 6.5 cm. 23. The pressure ulcer on the right heel measured 3.8 cm. by 3.0 cm. 24, The pressure ulcer on the coccyx area measured 4.5 cm. by 3.0 cm. with a depth of 2 cm. 25. The nurse was asked if the Resident received any pain medication prior to wound care. 26. Themmurse replied that "(the resident) always does that.” 27. The nurse continued with the dressing change, ignored the moaning and groaning of the Resident, and did not give the Resident any medication for pain relief. 28. A review of the clinical records revealed that the Resident was not assessed and care planned for pain. 29. A review of the medication administration record (MAR) did not reveal any orders for pain medication. 30. A review of Facility policy and procedure regarding treatment of wound care stated: "to assess resident for pain related to the pressure ulcer or its treatment. Offer/administer analgesia, if ordered, prior to dressing changes to promote resident comfort.” 31. | During an interview with the wound care nurse after the wound care procedure on May 15, 2007, at approximately 10:45 a.m., it was confirmed that the Resident moans and groans in pain every time when a dressing change is performed and that the Resident is not medicated for pain prior to the procedure. 32. During an interview with the unit manager on May 15, 2007, at approximately 11:00 a.m., it was verified that there were no orders for pain medication and the problem of pain was not communicated to her by the wound care nurse. 33. A review of the hospice nurse care plans did not reveal any documentation from the hospice staff. 34. The hospice nurses’ admission assessments/care plans were not in the clinical records. 35. | There was no coordinated interdisciplinary care plans between the Facility staff and the services of the hospice for pain and comfort measures. 36. The Respondent’s actions and/or inactions constituted an isolated state class Tl : deticiency as provided for by Florida iaw. 37. Acclass II deficiency is a deficiency that the Agency determines has compromised the resident's ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services.. § 400.23(8)(b), Fla. Stat. (2006). 38. A class II deficiency is subject to a civil penalty of $2,500 for an isolated deficiency, $5,000 for a patterned deficiency, and $7,500 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 fine shall be levied notwithstanding the correction of the deficiency. § 400.23(8)(b), Fla. Stat. (2006). 39. 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. 40. Asaresult, the administrative fine for the Facility’s isolated deficiency is doubled to $5,000. 41. The Respondent was given a mandatory correction date of June 8, 2007. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to impose an administrative fine against the Respondent in the amount of five thousand dollars ($5,000.00). . COUNT II Assignment of Conditional License 42. The Agency re-alleges and incorporates by reference paragraphs 1 through 5 and Count I. , 43. A conditional licensure status means that a Facility, due to the presence of one or more class I or class Il deficiencies, or class III deficiencies not corrected within the time established by the Agency, was 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 I, class II, or class Ill deficiencies at the time of the follow-up survey, a standard licensure status may be assigned. § 400.23(7)(b), Fla. Stat. (2006). 44. Due to the presence of one or more state class II deficiencies, or class III deficiencies not corrected within the time established by the Agency, the Respondent was not in substantial compliance at the time of the survey with criteria established under Chapter 400, Part IL, Florida Statutes, or the rules adopted by the Agency. 45. Asaresult of these deficiencies, the Respondent was subject it the assignment of a conditional licensure status. 46. The Agency issued the Respondent a conditional license with an action effective date of May 17, 2007. A copy of the original certificate is attached as Exhibit A. 47. The Agency issued the Respondent a conditional renewal license with an action effective date of June 1, 2007. A copy of the original certificate is attached as Exhibit B. 48. At the time of the follow-up survey, the Respondent had no class I, class II, or uncorrected class III deficiencies. 49. The Agency issued the Respondent a standard license with an action effective date of June 27, 2007. A copy of the original certificate is attached as Exhibit C. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to assign conditional licensure status to the Respondent, a skilled nursing facility. coramencing on May 17, 2007, and ending on June 27, 2007.. . CLAIM FOR KELIEK WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the following relief: 1. Make findings of fact and conclusions of law in favor of the Agency. 2. ° Impose an administrative fine against the Respondent in the total amount of five thousand dollars ($5,000.00). 3. Assign conditional licensure status to the Respondent for the period beginning on May 17, 2007, and ending on June 27, 2007. 4, Assess costs related to the investigation and prosecution, 5. Enter any other relief that this Court deems just andAppyopri Respectfully submitted this 20th day of July, 2007. Thomas M. Hocles SenterAttorney Florida Bar No. 709311 Agency for Health Care Administration Office of the General Counsel Sebring Building, Suite 330D 525 Mirror Lake Drive North St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 NOTICE The Respondent is notified that it/he/she has the right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. If the Respondent wants to hire an attorney, it/he/she has the right to be represented by an attorney in this matter. Specific - options for administrative action are set out in the attached Election of Rights form. The Respondent is further notified if the Election of Rights form is not received by the Agency for Health Care Administration within twenty-one (21) days of the receipt of this Administrative Complaint, a final order will be entered.. ‘The Election of Rights form shall be made to the Agency for Health Care Administration" and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL 32308; Telephone (850) 922-5873. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form were served to: Vereen Reynolds, Administrator, Guardian Care Nursing & Rehabilitation Center, 2500 West Church Street, Orlando, Florida 32805, by U.S. Certified f Thomas M. Hoeler, Senitr-Attorney Florida Bar No. 709311 Agency for Health Care Administration Office of the General Counsel 525 Mirror Lake Drive North, Suite 330D St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 Copies furnished to: Vereen Reynolds Thomas M. Hoeler, Senior Attorney Administrator Agency for Health Care Administration Guardian Care Nursing & Rehabilitation Ctr. Office of the General Counsel .2500 West Church Street 525 Mirror Lake Drive North, Suite 330D Orlando, Florida 32805 (Certified U.S. Mail) St. Petersburg, FL 33701 (Interoffice Mail) Michael P. Annichiarico Joel Libby Field Office Manager Registered Agent Guardian Care, Inc. Hurston South Tower 2500 West Church Street 400 West Robinson, Suite $309 Orlando, FL 32805 (US. Certified Mail) Orlando, FL 32801 (U.S. Mail)

Docket for Case No: 07-003640