STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case Nos. 2010002766 2010002771 MF LONGWOOD, LLC, d/b/a LONGWOOD HEALTH CARE CENTER, Respondent. / ADMINISTRATIVE COMPLAINT. COMES NOW the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter “Agency” or “Petitioner”), by and through the undersigned counsel, and files this Administrative Complaint against MF LONGWOOD, LLC, d/b/a LONGWOOD HEALTH CARE CENTER, (hereinafter “Respondent” or “Facility”), pursuant to §§120.569 and 120.57 Florida Statutes (2009), and alleges: . NATURE OF THE ACTION This is an action to change Respondent’s licensure status from Standard to Conditional commencing February 15, 2010 and ending March 10, 2010, and impose an administrative fine in the amount of one thousand dollars ($1,000.00), based upon Respondent being cited for one (1) uncorrected State Class III deficiency. JURISDICTION AND_VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2009). 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 Filed August 26, 2010 2:10 PM Division of Administrative Hearings. facilities pursuant to the Omnibus Reconciliation Act of 1987, Title IV, Subtitle C (as amended), Chapters 400, Part II, and 408, Part HI, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4. Respondent operates a 120-bed nursing home, located at 1520 S. Grant Street, Longwood, Florida 32750, and is licensed as a skilled nursing facility, license number 12970961. 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 (N201 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That pursuant to Florida law, residents’ rights include, inter alia, the following: 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: (1) 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, with established and recognized practice standards within the community, and with rules as adopted by the agency. See § 400.022(1)(1), Fla. Stat. (2009). 8. That Florida law, within the Nurse Practice Act of Chapter 464, defines “Practice of professional nursing” to mean, “the performance of selected acts, including the administration of Page 2 of 10 treatments and medications, in the care of the ill, injured, or infirm and the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. The professional nurse and the practical nurse shall be responsible and accountable for making decisions that are based upon the individual’s educational preparation and experience in nursing.” See § 464.003(3)(b), Fla. Stat. (2009). 9. That pursuant to Florida law, 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. See § 400.102(1), Florida Statutes (2009). 10. That on January 8, 2010 the Agency concluded a Recertification Survey of Respondent’s Facility. 11. That based on observation, interview and record review, the Facility failed to provide adequate indication for the use of an anti-cholinergic medication for one (1) of eighteen (18) sampled residents (specifically Resident No. 149, hereafter “R149”). 12. That a review of the medical records for R149 revealed R149 was readmitted to the Facility on 07/30/09 with diagnoses of Alzheimer’s dementia, hypertension, depression, history of coronary artery disease and contact dermatitis of the lower extremities. 13. That a review of the Medication Administration Record (hereafter “MAR”) revealed an order written on 08/25/09 for Hydroxyzine HCL 25 milligrams (mg.) one (1) tablet every six (6) hours as needed for anxiety. 14. That a review of the MAR for the month of December 2009 revealed that R149 received the medication on several occasions, and daily for January, 2010, for anxiety. Page 3 of 10 15. That the behavior monitoring sheet indicated R149 was anxious and resisting care. 16. That areview of the physician’s progress notes did not indicate the justification of the use of the anti-cholinergic medication for anxiety. 17. That the last psychiatrist follow-up note dated 12/30/09 verified the psychoactive medications, Sertraline 50 mg. daily and Mirtazapine 15 mg. every bed-time, both medications were used for diagnoses of depression. 18. That the psychiatrist documented to continue with the medications since, “patient was stable with current dose.” However, the use of the Hydroxyzine (Atarax) for anxiety was not addressed. 19. | That a review of the Facility’s drug information handbook indicated the Hydroxyzine (Atarax) medication is used as follows: a. For therapeutic category as antiemetic and antihistamine; b. Used for treatment of antianxiety; preoperative sedative, antipruritic; c. Special geriatric considerations anticholinergic effects are not well tolerated in the elderly and frequently result in bowel, bladder and mental status changes (i-e., constipation, confusion and urinary retention); and d. It is not recommended for use as a sedative or anxiolytic in the elderly. 20. That a review of the monthly pharmacy review revealed no recommendations or justifications for the use of Hydroxyzine for anti-anxiety. 21. That accordingly, Respondent failed to provide adequate and appropriate health care and protective and support services consistent with the care plan, with established and recognized practice standards within the community, and with rules as adopted by the Agency. Page 4 of 10 22. That the Agency provided Respondent with a mandatory correction date of 03/17/10. 23. That the Agency determined that this deficient practice was related to the personal care of the residents that will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the residents’ ability to maintain or reach his/her highest practical physical, mental, or psychosocial well-being and cited Respondent for a State Class III deficiency violation. 24. That on February 15, 2010 the Agency conducted a follow-up to the Recertification Survey of January 8, 2010. 25. That based on observation interview and record review, the Facility failed to ensure that one (1) of six (6) sampled residents were monitored upon return to the Facility after a medical procedure (specifically Resident No. 20, hereafter “R20”). 26. That pursuant to the Florida Department of Professional Regulation Chapter 464 Nursing Definition of Nursing Practice 464.003 (3) (a), “Practice of Professional Nursing” means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others. 2. That the administration of medications and treatments as prescribed or authorized by duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatment. 3. That the supervision and teaching of other personnel in the theory and performance of any of the above acts.” 27. That the observation of R20 on 02/15/10 at 12:23 p.m. revealed R20 was in bed watching television. Page 5 of 10 28. That R20 appeared to be comfortable and relaxed. 29. That a review of the nurses’ note: a. Dated 02/05/10 at 2:30 p.m. documented that R20 was going out for cystoscopy and stent removal on 02/11/10 at 2:00 p.m. b. On 02/15/10 revealed the last documentation was on 02/11/10 at 11:00 a.m. for leave of absence to doctor’s office for removal of stent: Alert and awake. 30. That there were no notes identifying that R20 returned to the Facility or reassessed upon return. 31. That an interview with the risk manager at 1:10 p.m. on 02/15/10, revealed that s/he would have expected some documentation upon return from the office procedure, as the documentation should have been present on return from stent removal. 32. That in an interview with R20’s 7-3 licensed practical nurse (hereafter “LPN”) on 02/15/10 at 1:00 p.m., s/he stated that: a. R20 had not complained of pain; b. It was monitored frequently; c. R20 had surgery to remove a stent in his/her kidney; and d. R20 did not mention any pain or concern upon his/her return. 33. That the nurse stated she had to check to see if anything was normal, urine was clean clear. If there was a redness we would have documented. The 3-11 nurse should have written the assessment note when the resident returned. 34. That in an interview at 1:50 p.m. on 02/15/10 with the 7:00 a.m. - 3:00 p.m. certified nursing aide that took care of R20, it was revealed she monitored urine on 02/12/10. If there was a problem she would have told the nurse. Page 6 of 10 35. That in an interview at 2:00 p.m. on 02/15/10, the LPN unit manager confirmed s/he did not know why there was no documentation. Documentation of resident’s condition should have been documented when patient returned to the Facility. “I would look for discharge instructions after a procedure.” S/he confirmed that discharge instructions were not in the clinical record. 36. That in an interview on 02/15/10 3:10 p.m. with the 3 - 11 pm. LPN who worked on 02/11/10., stated that the resident returned around 7:00 p.m. on 02/11/10. 37. That there were no orders with him/her upon return. The procedure was at the kidney stone center. 38. That a nurse called to say that the resident was returning to the Facility, the procedure went well, monitor if s/he voided fever, or had pain, The nurse would usually document at the end of shift. Confirmed that there should have been documentation that the resident was assessed upon return. 39. | That Respondent failed to provide adequate and appropriate health care and protective and support services consistent with the care plan, with established and recognized practice standards within the community, and with rules as adopted by the Agency including but not limited to: a. No assessment or re-assessment upon readmission; b. No discharge orders; and c. No documentation regarding discharge orders or indication of obtaining same. 40. That these failures, collectively and individually, constitute intentional or negligent acts that materially affected the health or safety of residents. 41. | That the Agency determined that this deficient practice was related to the personal care of the residents that will result in no more than minimal physical, mental, or psychosocial discomfort to the resident or has the potential to compromise the residents’ ability to maintain or Page 7 of 10 reach his or her highest practical physical, mental, or psychosocial well-being and cited Respondent for a State Class III deficiency, the same constituting an uncorrected deficient practice. 42. That the Agency provided Respondent with a mandatory correction date of 03/17/10. WHEREFORE, the Agency seeks to impose an administrative fine in the amount of $1,000.00 against Respondent, a skilled nursing facility in the State of Florida, pursuant to § 400.23(8)(c), Florida Statutes (2009). COUNT II (Conditional Licensure) 43. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Counts I and II of this Complaint as if fully set forth herein. 44. That based upon Respondent’s uncorrected State Class II 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 (2009). 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 (2009) commencing February 15, 2010 and ending March 10, 2010. [REMAINDER OF PAGE LEFT BLANK INTENTIONALLY] Page 8 of 10 qi Respectfully submitted this L% day of July, 2010. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION The Sebring Building 525 Mirror Lake Dr. N., Suite 330 St. Petersburg, Florida 33701 Telephone: (727) 552-1942 Facsimile: (727) 582-1440 E-mail: ThomasAsbury@ahca.myflorida.com DISPLAY OF LICENSE Pursuant to § 400.23(7)(d), Fla. Stat. (2009), Respondent shal! post the most current license in a prominent place and a list of the deficiencies of the facility shall be posted in 2 prominent place that is in clear and unobstructed public view at or near the place where residents are being admitted to that facility. Licensees receiving a conditional licensure status for a facility shall prepare, within 10 working days after receiving notice of deficiencies, a plan for correction of all deficiencies and shall submit the plan to the agency for approval. 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, Bldg #3, MS #3, Tallahassee, Florida, 32308, (850) 412-3630. RESPONDENT 1S 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. Page 9 of 10 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by USS. Certified Mail, Return Receipt No: 7004 2890 0000 5526 9517 on July _4_, 2010 to: Kimberly S. Boudrie, Administrator, Longwood Health Care Center, 1520 S. Grant Street, Longwood, Florida 32750. Copies furnished to: Longwood Health Care Center ATTN: Kimberly S. Boudrie, Admin. 1520 S. Grant Street Longwood, Florida 32750 (U.S. Certified Mail) Theresa DeCanio AHCA Field Office Manager Orlando, Florida (Interoffice) Thomas F. Asbury, Esq. Senior Attorney St. Petersburg, Florida (Interoffice) Thomds F. Asbury, Esquire Page 10 of 10 COMPLETE THIS SECTION ON DELIVERY (CD Dagent -_O Addresse SENDER: COMPLETE THIS SECTION ™ Complete items —_., and 3, Also complete item 4 If Restricted Delivery Is desired. @ Print your name and address on the reverso so that we can retum the card to you. ™@ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Atticla Addressed to: Longwood Health Care Center ATTN: Kimberly S. Boudrie, Administrator 1520 S, Grant Street Longwood, Florida 32750 5 Ronan Bera for Merchandts Clinsured Mai = OG00. . 4, Restricted Delivery? (Extra Fee) Ci Yes 2., Articla Number 7004 2a50 D000 $526 Adi? 2640 00776 an Boe re TR 291 2 T} : PS Form 3811, February 2004 Domestic Retum Receipt = ~ 102595-02-M-154

Docket for Case No: 10-008300