May 21 2009 13:20 MAY-21-2089 14:35 AGENCY HEALTH CARE ADMIN 856 921 4158 P.@8 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2009002735 (Fines) 2009002736 (Cond.) CAPITAL HEALTH CARE ASSOCIATES, LLC, d/b/a Capital Healthcare Center, Respondent i ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “Agency”), by and through the undersigned counsel, and files this Administrative Complaint against CAPITAL HEALTH CARE ASSOCIATES, LLC, d/b/a Capital Healthcare Center (hereinafter “Respondent”), pursuant to §§120.569 and 120.57 Florida Statutes (2008), and alleges: NATURE OF THE ACTION This is an action to change Respondent’s licensure status from Standard to Conditional commencing February 13, 2009 and ending March 17, 2009, and impose an administrative fine in the amount of $2,500.00, based upon Respondent being cited for one State Class II deficiency. JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2008). 2. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. May 21 2009 13:21 MAY-21-2EB9 14:33 AGENCY HEALTH CARE ADMIN 850 921 G158 =P. 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 $9A-4, Florida Administrative Code. 4. Respondent operates a 156-bed nursing home, located at 3333 Capital Medical Blvd., Tallahassee, Florida 32308, and is licensed as a skilled nursing facility (license number 1073096). 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. COUNTI 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. Florida law provides the following: a. Section 400.102(1), F.S., “In addition to the grounds listed in part II of chapter 408, any of the following conditions shall be grounds for action by the agency against a licensee: (1) An intentional or negligent act materially affecting the health or safety of residents of the facility...” b. Section 400.022(1)(1), F.S., “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, May 21 2009 13:21 MAY-21-2889 14:34 AGENCY HEALTH CARE ADMIN 856 921 @158 P.ia planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency.” c Section 400,121(1)(a), F.S., “The agency may deny an application, revoke or suspend a license, and impose an administrative fine, not to exceed $500 per violation per day for the violation of any provision of this part, part II of chapter 408, or applicable rules, against any applicant or licensee for the following violations by the applicant, licensee, or other controlling interest: A violation of any provision of this part, part II of chapter 408, or applicable rules.” 8. The Agency conducted a re-licensure survey starting on February 9, 2009 and ending February 13, 2009. 9. Based on observation, staff and resident interview and record review the facility failed to provide adequate and appropriate health care when t failed to follow the plan of care for hand mobility and range of motion and implement treatment that resulted in decline in range of motion . and contracture for 3 (#56, 98, 127) of the 7 sampled residents. Also, the facility failed to provide adequate and appropriate health care when it failed to provide proper foot care and treatment for 1 of 7 sampled residents (#89). The lack of proper care caused harm to the resident in the form of pain and drainage. 10. The findings regarding Resident #89 include: 11. An observation of Resident #89's toenails was conducted on 2/12/09 by two surveyors and a facility nurse. The resident’s bilateral great toe nails were about lem long, thick, discolored, and they curved upward at about a 90 degree angle to the toe. A 1.5cm area of yellowish drainage had soaked through the left sock where the sock touched the left great toe. On the left foot, the 2" and 4" toenails were also long and in need of trimming. On the right foot, the 3“ and 4” toenails were also noted in need of trimming. May 21 2009 13:21 MAY-21-2889 14:34 AGENCY HEALTH CARE ADMIN 856 921 4158 P.ii 12, An interview was conducted during the observation on 2/12/09 with Resident #89. Resident #89 was asked about his/her toes. Resident #89 stated, “Oh, they hurt so bad.” The resident was asked if he/she had told anyone at the facility. Resident #89 replied, “I’ve told everybody.” The nurse who was present stated that Resident #89 had not told her about the painful toe nails. 13. On 2/12/09 the nurse stated that she had notified the Unit Manager (LIM) who will call the podiatrist. An interview was conducted with the Unit Manager. The JM confirmed that she was about to notify the podiatrist. The UM waa asked about the dramage from the left great toe. The UM stated that she was unaware of the drainage and would go and assess the foot. 14. Physician progress notes were reviewed. The most recent progress note was dated 12/18/08. There was no mention of the toenails. 13. The 'Weekly Skin Sweep’ form was reviewed beginning on 7/31/08 through present, 2/11/09, On 10/30/08, a nurse wrote, "Toenails need clipping.” There is no other mention of the long, thick, angled toenails on the forms. There is no indication that the toenails were trimmed. 16. The care plans were reviewed. There was no mention of the toenails on the care plans. Resident #89 has a diagnosis of Diabetes Mellitus. No interventions regarding foot assessment, or nail care was found on the care plans. 17. In the care plan section of the medical record, a form dated 11/6/08 was found. The form stated that "Toe Nails Need Clipping” and was signed by the resident and the Minimum Data Set (MDS) coordinator. The next entry on the form was dated 1/23/09. There was no mention of the nails. The form was signed by the MDS coordinator, but not by the resident. 18. The most recent Minimum Data Set (MDS), dated 1/23/09, was reviewed. Resident #89 was assessed as requiring extensive assistance with one person physical assist for bed mobility, May 21 2009 13:22 MAY-21-2889 14:34 AGENCY HEALTH CARE ADMIN 856 921 4158 P.i2 transfer, dressing and personal hygiene. Under section M6 for Foot Problems and Care, the section for “None of the Above” was marked. 19. Aninterview was conducted with the MDS and Care Plan Coordinator: The MDS coordinator confirmed that both she and the resident signed the form that stated "Toe Nails Need Clipping." The MDS coordinator stated that she does not make the appointment, but that she lets nursing staff know. She stated that nursing staff will call the podiatrist. The MDS coordinator stated that the facility does not routinely imtiate a care plan for diabetes. She stated that care needs specific to problems identified are included on other care plans. The MDS coordinator referred to a nurses note dated J 1/7/08 that showed a podiatrist was contacted concerning Resident #89’s toenails. 20. The nurse's note was reviewed. On 11/7/08 at 2:15p.m., a nurse wrote, “(name of physician) office called. No longer has (insurance name). Has appointment for November 24th at 2:00p.m.” 21. Aninterview was conducted with the nurse who wrote the above note, The nurse confirmed that she made the appointment. However, the nurse stated that she did not follow-up on the appointment because Resident #89 transferred off of her wing on 11/12/08. 22. The nurses notes from 11/12/08 through present were reviewed. There was no further mention of Resident #89s toenails. There was no mention of the dramage from the left toe, of the resident's complaint that the toenails “hurt so bad”, nor was there mention that the toe nails were thick, long, or growing upward at a 90 degree angle to the toes. 23. An interview was conducted with the Director of Nursing (DON) about the long toenails identified 4 months ago in November 2008. The DON confirmed that the appointment was made, May 21 2009 13:22 MAY-21-2889 14:45 AGENCY HEALTH CARE ADMIN 856 921 4158 P.13 but the resident did not get his/her toenails trimmed on that date. The DON confirmed that the facility did not follow-up on the toenail care. 25, Findings regarding Resident #56 include: Observation noted resident #56 in bed with night hand closed without a splinting device to prevent contractures. Interview with the resident indicated he/she had a stroke and this left the hand paralyzed. The resident’s hand was observed on the following days at breakfast and lunch without splinting devices in the hand to prevent contractures: 2/9/09, 2/10/09, 2/11/09 and 2/12/09. Observation of these meals indicated the resident trying to feed self with one hand. 26. Interview with resident indicated he/she never has anything on the right hand to prevent contractures, 27. Review of the most current plan of carc indicates limited range of motion to mght hand with interventions to provide passive range of motion daily during moming and evening care and to monitor for changes in functional abilities. | 28. During an interview with the resident indicated the staff never does any range of motion to my hand. 29, During an interview with an aide, the aide stated, “we do range of motion during care.” 30. A nurse stated that the aides do range of motion to residents during care. 31. Review of the most current assessment dated 10/14/08 indicates limitation on one side with partial loss to the hand, fingers and wrist and indicates extensive assistance of one aide to total assistance with one aide for dressing, transfer, toileting and personal hygiene. Assessments dated 7/08 and 2/08 indicated the same. The record lacked evidence of a current restorative program or therapy program for range of motion or contractures. May 21 2009 13:22 MAY-21-2889 14:45 AGENCY HEALTH CARE ADMIN 856 921 4158 P.14 32. Record review indicated a referral dated 2/9/09 (after resident #56 was identified by the surveyor) for a therapy screen due to decrease in range in motion of right hand and digits and would benefit from skilled occupational therapy. The referral indicates splinting issues for nght hand, impaired range of motion, and needing extensive assistance with activities of daily living for dressing. 33. The staff failed to implement treatment which resulted in decline in range of motion and contracture to hand. 34. Findings for Resident #127 include the following: 35. Observation 2/9/09 noted resident #127 in the dining room for lunch with both hand closed without splinting devices. 36. Observation of lunch 2/10/09, 2/11/09 and 2/12/09 from indicated the same. 37, Review of quarterly Minimum Data Set (MDS) dated 11/18/08 and 8/20/08 noted total care with activities of daily living (ADL's). Functional limitations in range of motion indicated hand limitation on both sides with partial loss. It also indicated total dependence with full staff performance of one person assist for eating . No therapy was indicated in last 7 days of the assessment period, and no restorative program or devices was noted. MDS dated 12/24/07 indicates no lirnitation with range of motion related to hand. 38. The record lacked a plan of care for limited range of motion or contractures. The plan of care states tota] assistance with assistance with activities of daily living. 39, Observation. on 2/12/09 with staff nurse indicated the resident had difficulty opening left hand. The hand smelled sour and the resident had long dirty nails that were digging into palm of hand. May 21 2009 13:23 MAY-21-2889 14:45 AGENCY HEALTH CARE ADMIN 856 921 4158 P.is 40. During an interview with an aide, the aide stated, “do range of motion during care and report issues to nurses.” 4]. The Occupational Therapist (OT) was interviewed and he stated he worked with this resident last year in 6/08 with a long term goal for staff to provide range of motion to prevent decline. 42, The director of nursing (DON) slated, “If assessment shows limited range of motion then a screen should have been completed.” 43. A screen was completed by Occupational Therapy on 2/12/09 which indicated contractures of both hands with shortening of nght and left fingers and would benefit from. Occupational therapy interventions. 44. —- Findings regarding resident #98 include: 45, Observation of resident #98 during the initial tour conducted revealed the resident's left hand was balled into a fist with the thumb protruding between the third and fourth fingers. There was no observation of any splinting device or any other type of device applied. 46. During observation of resident #98 on 2/11/09 while the resident was in the activity room it was noted the left hand was in the same condition as described above. A nursing assistant familiar with the resident, though not working with the resident on this date, attempted to have the resident open her left hand but was unable to do so. At that time the resident's Unit Manager, who is also a Licensed Practical Nurse (LPN) was successful in having the resident open her left hand but stated at that time the resident was beginning to show signs of having the left hand contract and would need to have something placed im her hand to help prevent contracture. She stated she would ask Occupational Therapy to screen the resident. May 21 2009 13:23 MAY-21-2889 14°36 AGENCY HEALTH CARE ADMIN 856 921 4158 P.16 47. Areview of the resident's most recent Minimum Data Set assessment dated 12/12/08 does not document any functional range of motion to either hand. 48. Interview and record review with the Occupational Therapist revealed he had screened the resident and although the resident does not have a contracture he/she does have impaired upper extremity range of motion and he agreed with the unit LPN that the resident would have issues with contracture of the left hand without treatment. He documented his plan on a form labeled "Interdisciplinary Functional Status Form" dated 2/12/09 that he would "instruct CNAs (certified nursing assistants) on maintenance program to prevent contracture." 49. The Respondent has the legal duty to provide adequate and appropmate health pursuant to s. 400,.022(1)(1), F.8. The Respondent intentionally or negligently failed to provide adequate and appropriate health care when it failed to implement treatment for contraction and provide occupational therapy for 3 residents: #56, 98, and 127. Also, the facility failed to provide adequate and appropriate health care when it failed to provide proper foot care and treatment for resident #89. The Respondent's intentional or negligent acts materially affected the residents’ health because the Respondent’s failurcs led to decline in range of motion and contracture for 3 residents and pain and drainage for one resident. Therefore, the Agency has authority pursuant to § 400.102(1), F.S., to take action against the Respondent. 50. The above findings reflect Respondent’s intentional or negligent failure to provide adequate and appropriate health care, thus the Respondent’s actions constituted a Class II deficiency, pursuant of § 400.023(8)(b), Florida Statutes(2008). 51. Pursuant to § 400.102(1), F.S., any intentional or negligent act that materially affects the health or safety of a resident is grounds for administrative action. The Respondent has been cited for multiple acts, international or negligent, that materially affected the health of its May 21 2009 13:23 MAY-21-2889 14°36 AGENCY HEALTH CARE ADMIN 856 921 4158 P.1? residents, The Agency has supported its citations with specific factual findings thal support the alleged deficiencies. Therefore, pursuant to §§ 400.022(1)(1}, 400.102(1), and 400.023(8)(a) Florida Statutes (2008), the Agency has sufficient grounds for taking this administrative action against the Respondent. 52. The Agency provided Respondent with the mandatory correction date for this deficient practice of March 13, 2009. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,500.00 against Respondent, a nursing facility in the State of Florida, pursuant to §§ 400.23(8)(b) and 400,102, Florida Statutes (2008). COUNT It 53. The Agency re-alleges and incorporates Count J of this Complaint as if fully set forth herein. 54. Based upon Respondent’s cited State Class Il 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 (2008). WHEREFORE, the Agency intends to assign a conditional licensure status to Respondent, a nursing facility in the State of Florida, pursuant to § 400.23(7), Florida Statutes (2008) commencing February 13, 2009 and ending March 17, 2009. CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court: May 21 2009 13:24 MAY-21-2889 14°36 AGENCY HEALTH CARE ADMIN 856 921 4158 P.18 (A) Make factual and legal findings in favor of the Agency on Count I and II; (B) Recommend an administrative fine against Respondent in the amount of $2,500 for Count J, an isolated Class II deficiency; (C) Assign a conditional licensure status commencing February 13, 2009 and ending March 17, 2009; (D) Assess attomey’s fees and costs; and (E) Grant all other general and equitable relief allowed by law. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights form. All requests for hearing shall be made to the attention of Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308, (850) 922-5873. If you want to hire an attorney, you have the right to be represented by an attorney m this matter. RESPONDENT JS 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 April 76 , 2009. cxallied tt Mok wh, Fla. Bar.48084 Agency for Health Care Admin. 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 850.922.5873 (office) 850.921.0158 (fax) May 21 2009 13:24 MAY-21-2889 14:36 AGENCY HEALTH CARE ADMIN 856 921 @158 P.i9 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 2890 0000 5526 8985 to: Facility Administrator Thomas L. McDaniel, Capital Healthcare Center, 3333 Capita] Medical Blvd., Tallahassee, Florida 32308, by U.S. Certified Mail, Return Receipt No. 7004 2890 0000 5526 8992 to: Owner Capital Health Care Associates, LLC, d/b/a Capital Healthoare Center, 10210 Highland Manor Drive, Suite 250, Tampa, Florida 33610, and by U 8. Certified Mail, Return Receipt No. 7004 2890 0000 5526 9005 to Registered Agent Corporation Service Company, 1201 Hays Street, Tallahassee, Florida 32301 on April 3.0, 2009: ia Monle nal 4 Mark Hinely ; Copy furnished to: Barbara Alford, FOM

Docket for Case No: 09-002838