buy (fees STATE OF FLORIDA . Oe » if Ey AGENCY FOR HEALTH CARE ADMINISTRATION a7, s) — uty. 3 -S\S Wiley % STATE OF FLORIDA, 0 ¥ > ste UG SIN Om $8 AGENCY FOR HEALTH CARE . WT ADMINISTRATION, . Petitioner, vs. Case Nos. 2008007532 (Fines) 2008007533 (Cond.) RIVERWOOD NURSING CENTER, Respondent / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against RIVERWOOD NURSING CENTER, (hereinafter “Respondent”), pursuant to §§120.569 and 120.57, Florida Statutes (2007), and alleges: NATURE OF THE ACTION This is an action to change Respondent's licensure status from Standard to Conditional commencing May 21, 2008, and ending June 25, 2008, and impose an administrative fine in the amount of $3,000, based upon being cited for one uncorrected, widespread Class III deficiency. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2007). 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. PARTIES 3. The Agency is the regulatory authority responsible for licensure of nursing homes and enforcement of applicable federal regulations, state statutes and rules governing skilled nursing facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4. Respondent operates a 119-bed nursing home, located at 40 Acme Street, Jacksonville, Florida 32211, and is licensed as a nursing home license number 1508095. 5. Respondent was at all times material hereto, a licensed nursing facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes, COUNT I RESPONDENT'S FACILITY FAILED TO PROVIDE DOCUMENTATION THAT CERTIFIED NURSING ASSISTANTS RECEIVED 12 HOURS OF STAFF INSERVICING ON A YEARLY BASIS REQUIRED FOR CERFICIATION OF CNAs. § 400.211(4), Fla. Stat. (2007) WIDESPREAD CLASS III DEFICIENCY 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That Florida Law provides that when employed by a nursing home facility for a 12- month period or longer, a nursing assistant, to maintain certification, shall submit to a performance review every 12 months and must receive regular inservice education based on the outcome of such reviews. The inservice training must be sufficient to ensure the continuing competence of nursing assistants and must meet the standard specified in s. 464.203(7). The training must 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. The training must 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. Costs associated with this training may not be reimbursed from additional Medicaid funding through interim rate adjustments. 8. That on April 17, 2008, the Agency conducted an annual recertification survey at the Respondent’s facility. 9. Based on facility provided documentation of inservice calendars since February, 2008 through March, 2008, employee inservice records for 10 employees, and interview with staff, the facility failed to ensure that nursing assistants receive inservice training to maintain their certification. The facility failed to ensure that 12 hours of inservice was provided to the nurse aides within their designated calendar year. There was no evidence that the following inservices had been conducted and attended by the appropriate staff: Prevention and control of infection; Fire prevention, life safety, and disaster preparedness; Accident prevention and safety awareness programs, Resident's rights; techniques for assisting with eating and proper feeding; principles of adequate nutrion and hydration; techniques for assisting and responding to the cognitively impaired resident or the resident with difficult behaviors; techniques for caring for the resident at . the end-of-life; and recognizing changes that place a resident at risk for pressure ulcers and falls. The CMS-672 reveals that at least 75% of the facility residents have documented psychiatric diagnosis and have ADL (Activities of Daily Living) needs that if the facility failed to provide inservice on a contimmous yearly basis may result in the staff lack of knowledge of how to perform care and provided services to all residents residing in the facility. The current education system would not ensure that nursing aides received the 12 hours. per calendar year of required inservices. The findings include: 1. A review of the monthly calendars on 4/17/08 at 10 am noted monthly inservices to be held for employees but no sign-in sheets were in the calendar. Interview with the employee on 4/17/08 at 11:35 am who was responsible for In-service training revealed a-sign-in book for employees that attended the inservice. She presented an Inservice book that revealed sign-in sheets of staff attending each inservice. A comparison of the monthly calendars and the inservices with employee sign-in sheets revealed the following: a. February, 2007 - The calendar listed 12 of what the facility identified as Mandatory inservice for all staff "throughout the month". Listed on the reverse page was "Xtra Infection control and universal precautions", noted for 2/21/07. There was no evidence of a sign-in sheet to indicate which staff members had attended the inservice. b. March, 2007 "Mandatories listed on calendar", such as 3/15/2007. There was no sign-in sheet. There was no indication of the mandatory inservices to be provided to staff nor a sign-in sheet to indicate that the staff had attended. c. April, 2007 "Continue mandatory inservices until all staff complete. Xtra infection control - biohaz waste for 4/25/07". There was no indication of the mandatory inservices to be provided to staff nor a sign-in sheet to indicate that the staff had attended. d. May 2007 - Infection control and Biohaz waste was scheduled for May 14, 2007. There was no sign-in sheet of staff attending this inservice. HIV/AIDS on the 22nd and 23rd. There was a sign-in sheet that revealed that for both days approximately 64 staff members attended the inservices. e. June 2007 - "Alz inservice - 3 hr. course on the 13th, infection control, Biohaz waste on the 15th. Did not occur". On June 21, 22, 23 Nursing Duties for Improper assign. Sheets, Medicare charting, holes in Mars, Narcotic sheet, skin assessments, initially mars, tars, behavior books, nursing reminders on charting was to be held. There was no indication of staff attendance. f. July 2007- License notification, risk management was scheduled for July 23, ‘2007. There was no indication of staff attendance. July 25, 2007 - Infection control, biohaz waste. There was no indication of staff attendance. July 30, 2007 - TB, POS, PPD, Exposure. There was no.indication of staff attendance. The inservice training reports reveal Alzheimers inservice for July 13, 3007 attended by only 16 staff members - 1 LPN. g. August 2007 - HIV/AIDS for Aug 22, infection control Biohaz waste on Aug. 28, 2007: This inservice had a sign-in sheet that revealed 19 staff members attended, including housekeeping/laundry/Floor techs/others. h. September 19, 2007 - Infection control inservice sign-in sheet revealed that 12 staff members attended. 9/24/07 CNAs skin infection, universal standard precautions, infection control issues, proper washing of hands, records, confidentiality noted a sign in sheet where 25 employees attended, mostly CNAs and Risk Managers were in attendance. i. October 4, 2007 - Shaving residents properly inservice was attended by 14 CNAs. j. November of 2007 - Alzheimers 3 hour course was attended by 3 staff members, LPN, CAN : Alzheimers training was scheduled for November 19, 2007 but there was no evidence that the training took place or who was in attendance. k. December 31, 2007 - Biohaz waste inservice was attended by Housekeepers/Laundry/Floor Care. 1. January 2008 inservices were listed on the calendar for the following dates: 1/22 - Medicare charting; 1/29 - Biohazard waster, infection control - "2008 mandatory inservice begin for all employees". There was evidence that 9 employees with Laundry/housekeeping, floor care were in attendance. m. February 2008 - "Continued mandatory inservices for all employees through the month. There were no inservices listed in the training book in addition to no employee sign-in sheets. n. March 2008 - There were no inservices listed on the calendar for this month. However in the separate inservice book an inservice was noted on 3/31/08 for CNAs.and nurse - "redirection of residents and keep them from going into other resident's rooms". There were 31 staff members in attendance. 2. Further interview with the employee on 4/17/08 at 11:35 am who was responsible for In-service training revealed a set of papers entitled Southwood Nursing Center, Inc. Employee Inservice Record, She indicated that this was completed for all staff members after having attended inservices inthe facility. She further stated that she used these sign in sheets to complete the Employee Inservice Record that listed twelve inservices: Risk Management, Fed and State regulations, Resident Rights, Hep B/TB, Fir Prev./Life Safety/Disaster Preparedness, HIV, /AIDS, Biohazard/Wed Waste, Right to Know, Prev and Control of Infection, Safe transfer and Body Mechanics, Accident Prevention/Safety Awareness, and Medicare and Medicaid Fraud. 3. The Employee Inservice Record was reviewed for Employee #5 and #7, who had been employed in the facility for over 1 year, that would reflect the inservice provided to these Certified Nursing Assistance (CNAs) in accordance with the facility's inservice calendar, sign-in sheets and subsequently listed on their individual Employee Inservice Record. There was no correlation between the facility's monthly calendars, sign-in sheets and each employee record. Each employee (CNA) had an Employee Inservice Record that revealed the following: a. Their name, date of hire, department and a statement "I acknowledge my receipt of written and/or verbal information received for each of the Inservices listed. | acknowledge each inservice provides information equivalent to one hour of content.” b. The employee signature and a date was noted under the statement. 1) A review of Employee #5's record revealed that the employee had signed and dated, 2/7/08, their inservice record. 2) A review of Employee #7's record revealed that.the employee had signed and dated, 2/7/08, their inservice record. c. The inservice titles were listed - Risk Management, Fed and State regulations, Resident Rights, Hep B/TB, Fir Prev./Life Safety/Disaster Preparedness, HIV/AIDS, Biohazard/Wed Waste, Right to Know, Prev and Control of Infection, Safe transfer and Body Mechanics, Accident Prevention/Safety Awareness, and Medicare and Medicaid Fraud, which was to be an equivalent to one hour, a supervisor name and their initials. 4. On 4/17/08 at approximately 3 PM the facility staff was made aware of the lack of documentation that would reflect that each employee received the appropriate training. The current education system would not ensure that nursing aides received the 12 hours per calendar year. ~ 10. The Agency provided Respondent with a mandatory correction date of May. 18, 2008. 11. That on May 21, 2008, the Agency conducted a revisit survey to the complaint investigation of April 17, 2008, at Respondent’s facility. 12. Based on record review and interview, the facility failed to provide documentation that five of five employees, Certified Nursing Assistants (CNA), received 12 hours of staff inservicing on a yearly basis required for certification of CNAs. There was no evidence that would have ensured that staff had proof of attendance. Failure to ensure inservice education programs were held and attended could result in staff not consistently applying interventions necessary to meet residents’ needs. The findings include: 1. Personnel records were reviewed for 5 Certified Nursing Assistants (CNA), Employee #1, #2, #3, #4 and #5. Review of each of the records revealed that the facility had them sign a form acknowledging receipt of written and/or verbal information on May 7, 2008. The single sheet listed 6 different inservice training. Also in the Employee Inservice Record/Calendar Book were individual employee inservice records signed acknowledging receipt of written and/or verbal information on February 7, 2008. However there were no sign-in sheets with the in- service calendar per Plan of Correction. 2. Employee #5 had the May 7, 2008 form signed by the employee noting that the employee had received inservices for: Techniques for assisting with eating and proper feeding; Principles of adequate nutrition and hydration; Techniques for assisting and responding to the cognitively impaired resident or the resident with difficult behaviors; Techniques for caring for - the resident at the end-of-life; recognizing changes that place a resident at risk for pressure ulcers; and Falls in the Elderly. However there was no indication or evidence of a date when the employee received the inservice. There was no calendar or sign-in sheet giving proof of inservices. 3. On 5/21/2008 at 1:30 PM during an interview with the Director of Nursing (DON) and the Human Resources Manager (HRM) the DON stated that there were no sign in sheets from any of these inservices, as she used the facility forms mentioned above. | 13. The above constitutes a violation of § 400.211(4), Fla. Stat. (2007), and constitutes a widespread Class Ill deficiency pursuant to § 400.23(8)(c), Fla. Stat. (2007). 14. The Agency provided Respondent with a mandatory correction date of June 20, 2008. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $3,000.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §§ 400.23(8)(c) and 400.211(4), Florida Statutes (2007). COUNT II 15. The Agency re-alleges and incorporates Count I of this Complaint as if fully set forth herein. 16. Based upon Respondent’s uncorrected Class III deficiency, it was not in substantial compliance at the time of the survey with criteria established under Part II of Florida Statute 400, or the rules adopted by the Agency, a violation subjecting it to assignment of a conditional licensure status under § 400.23(7)(b), Florida Statutes (2007). WHEREFORE, the Agency intends to assign a conditional licensure status to Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(7), Florida Statutes (2007) commencing May 21, 2008, and ending June 25, 2008. CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court: (A) Make factual and legal findings in favor of the Agency on Count I and Count I; (B) Recommend an administrative fine against Respondent in the amount of $3,000 for Count I; (C) Grant all other general and equitable relief allowed by law, Respectfully submitted this day of August, 2008. Shaddrick A. Haston, Esq, Fla. Bar. No. 31067 Agency for Health Care Admin. 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 850.922.5873 (office) 850.921.0158 (fax) DISPLAY OF LICENSE Pursuant to § 400.23(7)(e), Florida Statutes (2007), Respondent shall post the most current 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. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Rights. All requests for hearing shall be made to the attention of: The Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bidg #3, MS #3, Tallahassee, Florida, 32308, (850) 922-5873. : RESPONDENT IS FURTHER NOTIFIED THAT A REQUEST FOR HEARING MUST BE RECEIVED WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT OR WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7004 1160 0003 3739 4172 to Facility Administrator Terry K. Carpenter, 1839 Tumberry Court, Green Cove Springs, Florida 32043, by U.S. Certified Mail, Return Receipt No. 7004 1160 0003 3739 4189 to Owner, Riverwood Nursing Center LLC, 40 Acme Street, Jacksonville, Florida 32211, and by U.S. Certified Mail, Return Receipt No. 7004 1160 0003 3739 4196 to Registered Agent, John F. Gilroy, III, 1435 Piedmont Drive, Suite 215, Tallahassee, Florida 32308 on August if 008: Copy furnished to: Nancy K. Marsh, RN, FOM

Docket for Case No: 08-005156