STATE OF FLORIDA oe AGENCY FOR HEALTH CARE ADMINISTRATION :.- STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Boe ve. Case Nos. 2010011288". 2020001289 WATERMAN COMMUNITIES, INC,, d/b/a ee THE EDGEWATER AT WATERMAN VILLAGE, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida's Agency for Health’ Care. Administration (the “Agency”) and files this administrative complaint against Waterman Communities, Inc., d/b/a The Edgewater at Waterman Village (“Respondent”), pursuant to’ ss” 120.569 and 120.57, Florida Statutes, and alleges: NATURE OF THR ACTION Thig ig an action to change Respondent's license status: |: from Standard to Conditional commencing October 5, 2010, and: ending November 16, 2010, and to impoge an administrative fine in the sum of two thousand five hundred dollars ($2,500i00), based upon Respondent being cited for one State Class Ir : deficiency. JURISDICTION AND VENUE i. The Agency tas jurisdiction pursuant—to s—20760-— Chapter 408, Part II, and Chapter 400, Part IT, Florida Page 1 of 15 Filed April 26, 2011 2:21 PM Division of Administrative Hearings Statutes. 2. Venue lies pursuant to Florida Administrative Code Rule 28-106.207. 7 PARTIES 3. The Agency is the regulatory authority responsible for *. licensing nursing homes and enforcing all applicable federal . regulations, state statutes and rules governing skilled muréing. facilities pursuant to the Omnibus Reconciliation Act. of 1987 Title IV, Subtitle C (as amended), Chapter 400, Part: I; “ploriaa a Statutes, and Chapter 59A-4, Florida Administrative Code. i: 4. Respondent operates a 120-bed nursing home, located at “300 Brookfield Avenue, Mount Dora, Florida 32757, and, ae licensed as a skilled nursing facility license number ° 1138096. 5. At all times material to the allegations of this - administrative complaint, Respondent was a licensed nursing’; facility under the licensing authority of the Agency and was” required to comply with all applicable rules, and statutes.” COUNT I os : 6. The Agency re-alleges and incorporates paragraphs ‘one. | (1) through five (5), as if set forth fully in'this count... * 7. Pursuant to Section 400.022(1) (1), Florida Statute: (1) All licensees of nursing home facilities shall. a 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 = - Page 2 of 15 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. (3) Any violation of the resident's rights set forth: in this section shall constitute grounds for action by. the agency under the provisions of s. 400.102, 400.121, or part II of chapter 408. In order to” determine whether the licensee is adequately protecting residents' rights, the licensure inspection of the facility shall include private informal : conversations with a sample of residents to discuss: . regidents' experiences within the facility with . respect to rights specified in this section and. general compliance with standards, and consultation with the ombudsman council in the local planning’ and service area of the Department of Elderly Affairs in. io which the nursing home is located, 8. Section 400.102, Fla. Stat., provides: 400.102 Action by agency against licensee; ground 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. 9. affecting the health or safety of residents of then facility; ne 9. Section 400.121, Florida Statutes, provides: - | 400.121 Denial, suspension, revocation of license;. administrative fines; procedure; order to increase : staffing. ~- : (1) The agency may deny an application, revoke | ox. suspend a license, and impose an administrative fine, . : not to exceed $500 per violation per day for the’ io violation of any provision OF this part, part IT OF chapter 408, or applicable rules, against any ee applicant or licensee for the following violations by. Page 3 of 15 the applicant, licensee, or other controlling interest; . (a) A violation of any provision of this part, part II of chapter 408, or applicable rules; or (b) ; re (2) Except as provided in s. 400.23(8), a $500 fine’ - shall be imposed for each violation. Each daya_ “= violation of this part or part II of chapter 408°. oe occurs constitutes a separate violation and is subjéct’ Lo to a separate fine, but in no event may any fine: : aggregate more than $5,000. A fine may be levied. pursuant to this section in lieu of and ‘fs notwithstanding the provisions of s. 400.23. Fines. paid shall be deposited in the Health Care Trust’ Fund » and expended as provided in s. 400.063. 10. Section 400.23, Fla. Stat., provides: (8) The agency shall adopt rules pursuant to this.” part and part II of chapter 408 to provide that, .. whert- the criteria established under subsection (2) are. not: met, such deficiencies shall be classified according, to the nature and the scope of the deficiency. The | scope shall be cited as isolated, patterned, or widespread. An isolated deficiency is a deficiency. - affecting one or a very limited number of residents or involving one or a very limited number of staff, :or. a situation that occurred only occasionally or dn: a Soe very limited number of locations. A patterned wee deficiency is a deficiency where more than a very ° : limited number of residents are affected, or more. thai a very limited number of staff are involved, or the. : situation has occurred in several locations, or the. same resident or residents have been affected by. ~~. | repeated occurrences of the same deficient practice. ~ but the effect of the deficient practice is not’ found . to be pervasive throughout the facility. A widespread: deficiency is a deficiency in which the problems: causing the deficiency are pervasive in the facility or represent systemic failure that has affected or: has _the potential to affect a large portion of the ‘ facility's residents. The agency shall indicate ‘the. classification on the face of the notice of deficiencies as follows: (b) A class II deficiency is a deficiency that the . agency determines has compromised the resident's Page 4 of 15 ability to maintain or reach hig 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, A class II deficiency is subject to a oivia penalty of $2,500 for an isolated deficiency, $5; 000. for a patterned deficiency, and $7,500 fora : 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 Ir. deficiencies during the last licensure inspection or any inspection or complaint investigation since the ee last licensure inspection, A fine shall be levied Jt se notwithstanding the correction of the deficiency...” 11. Section 464.003(3), Florida Statutes, defines: (3) (a) "Practice of professional nursing" meang “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: we include, but not be limited to: 1. The observation, assessment, nursing diagnosis, ole, planning, intervention, and evaluation of care;. health: 2 teaching and counseling of the i11, injured, or’ infixm; and the promotion of wellness, maintenance: “of | ae health, and prevention of illness of others. : 2. The administration of medications and treatments: aa. prescribed or authorized by a duly licensed hot os practitioner authorized by the laws of this state’ to ee prescribe such medications and treatments. . ‘ ‘3, The supervision and teaching of other personnel 47 the theory and performance of any of the above acts. (bo) "Practice of practical nursing" means the — performance of selected acts, including the a administration of treatments and medications, in’ the gare of the i11, injured, or infirm and the promotion of wellness, maintenance of health, and prevention: of. illness of others under the davect ion ofa registered nurse, a licensed physician, a licensed osteopathic “ physician, a licensed pediatric physician, or a licensed dentist. The professional nurse and the practical nurse: ‘shalt be responsible and accountable for making decisions: that are based upon the individual's educational eon! preparation and experience in nursing. Page 5 of 15 12. On October 5, 2010, the Agency conducted a complaint | investigation survey at Respondent's facility. 13. Based on the Agency's surveyor’s interviews and. mo review of the Respondent’s records, the Agency concluded: that o Respondent intentionally or negligently failed to provide appropriate care and services to observe, assess, identify, ., intervene and evaluate indicators identified by a resideht' s . health care provider as possible complications that would ‘affect. the resident's health for one resident, Resident #2, of three a residents whose records were reviewed. Specifically, upon ‘réturn ' from the hospital following an injury to Resident #2's head, Respondent failed to observe, assess, identify, interve a," evaluate and timely respond to Resident #2's signs of, complication from the head injury, signs which had been’ specified and furnished ‘to Respondent by Resident #2/e health.) ° care provider, resulting in Resident #2 being found wiresporigive. and requiring emergency transport to the hospital, where. Resident #2 died. 14.. The Agency surveyor’s review of the discharge ® 4 instructions in Respondent’s record for Resident #2. revealed | oo that Resident #2 suffered a head injury after a fall on Atigust . oo 26, 2010, at 3:35 A.M. Resident #2 was discharged from’ the: emergency room back to the facility on August 26, 2010," at, 9505. . Page 6 of 15° A.M., with instructions to "seek immediate medical care: vit there is confusion or drowsiness," or if "you can not awaken “the: injured person," 15. The nursing note dated August 26, 2010, at 12:30 ‘P M. wt stated that Resident #2 was eating lunch and did not. have .a: . headache or blurry vision. At that time Resident #2's blood’ 9 pressure was 108/87, making the pulse pressure 21. The pulse |: - was recorded as 76. 16. Under commonly accepted principles of nursing practice, widening pulse pressure -- the difference: batw systolic and diastolic pressures -- may be indicative of increasing inter-cranial pressure (ICP), a potentialiy, tater: complication of a head injury. an 17. The Agency’s surveyor'’s review of Respondent's ‘iursing * note dated August 26, 2010, and for 10:00 P.M, revealed that the resident was. "alert and oriented to self with periods of.” confusion," 18. The Agency’s surveyor’s review of Respondent's. nursing note dated August 27, 2010, for 12:45 P.M, revealed that | Resident #2 was assessed to be unresponsive, and a physic notified. The note further reveals that the physician ordered - emergency services to be called. Blood pressure was’ recordea: as: 162/62, making the pulse pressure r00. The pulse was requried as 45. Page 7 of 15 ‘drowsiness,” or if "you cannot awaken the injured pergo: 19. Respondent’s nursing note dated August 27, 2010), ‘and : timed 15 minutes later at 1:00 ‘iB. m., reveals that emergency services were notified. Resident #2 was transferred to: the: hospital on August 27, 2010, at 1:25 P.M, 20, The nursing note dated August 28, 2010, and . tained, at - 10:15 A.M. reveals that the adult child of the resident came’ “to: the. facility to pick up the resident's belonging, and at chat time informed the facility that Resident #2 expired’ during the night. 21. No nursing notes were entered in Respondent's recbrs for Resident #2 between the note on August 26, 2010, “at LO: 00. P.M., and the note on August 27, 2010, at 12:45 pom. early, fifteen (15) hours later. No other assessments of the resident's status were identified in Respondent’ s records 22. Respondent received written discharge instructions setting forth the care and services needed by Resident, 48: "[S]leek immediate medical care if there is confusion ort Respondent’s own nursing notes show that at 10:00 pom. n' August: 26, 2010, Resident #2 was experiencing “periods of confusion: Yet, Respondent intentionally or negligently ignored the discharge instructions provided to Respondent, making” assessment or Restdent #2 until nearly fifteen (15) hotte- tater; when Resident #2 was unresponsive and immediate emergency care’ Page 8 of 15 was ordered. Respondent's failure to observe, assess, identify; . intervene and evaluate indicators identified in Resident#2’5 7 discharge orders by Resident #2’s health care provider aso possible complications was a failure by Respondent to: provide. © appropriate care and services to Resident #2, in violation Of Resident #2's rights pursuant to § 400.022(1) (1), Fla, Stat, 23. The Agency surveyor’s review of the Medication Administration Record for the date of August 27,. 2010, reveals that the medications timed for 9:00 A.M. were held, “and. that ‘the O reason given was "patient sleepy' and "patient unable. to: take. Again, then, at 9:00 a.m. on August 27, 2010, Responden intentionally or negligently ignored Resident #2's discharge. instructions, which specified: "(Sleek immediate medical. “oa if there is confusion or drowsiness", or if "you caiinot’ awaken the injured person," 24. Ina telephone interview on October 5, 2010, P.M, with the nurse who was caring for Resident #2 on august 24; 2010, during the morning hours, the nurse told the agency’ surveyor that she found the resident to be sleepy on th T ining a of August 27, 2010, and that she had to hold the residen medications. She also stated that she had had this probleni, before. When questioned why no other days were marked hat, medication was held she stated," I—dorn't knowy” Winer aieed be she performed any further neurologic assessments after’ Page 9 of 15 determining that the resident was lethargic, Respondents. nurse stated, "No.” Respondent's nurse also stated that ashe had Lo instructed the nursing assistant to let the resident sleep’ 25. During a telephone interview with the adult, ‘chil o£ Resident #2 on October 5, 2010, at 1:00 P.M., he/she t coud ‘the Agency’s surveyor that the he/she had attempted to call. ‘the. resident multiple times during the morning of August Si, adie. and had been told that the resident was sleeping. The adult. child of Resident #2 also told the Agency’s surveyor ‘that concern prompted the adult child’s visit to the facility, and, that upon arrival Resident #2 was unable to be awakened, aiid, ‘he Respondent's nurse was notified. The adult child i of 8 jident sha also stated that the nurse's initial response was that resident was sleepy. The adult child of Resident #2. also stated that at that point a demand was made to see the resident which time the nurse visited the resident, and confirmed that i the resident was not responding and told the adult chil of Resident #2 that the resident's vitals were stable. “the ada os child of Resident #2 told the Agency’ 8 surveyor that she’ had: to demand that the doctor be notified regarding Resident po 8 = condition. The adult child also stated that a demand ‘Had’ ‘to be me made to call emergency services immediately as the nurse stated’. that she had to- complete the paperwork prior_te-vatting= Page 10 of 15 26. The Agency’s surveyor reviewed the Respondent's ‘policy: entitled "Charting and Documentation." The Respondent's policy. +; provides that, "[a]11 observations, medications administeréd,... services performed, etc. must be documented in the resident: He clinical record. . . . All incidents, accidents, or. changes in’. the resident's condition must be recorded." 27. Review of the Respondent's policy entitled chan a resident's Condition or Status" reveals that [t]he Nurse | ws Supervisor/Charge Nurse will notify the resident's Attend ng’ Physician or On-Call Physician when there has been: a a. A significant change in the resident's ‘ oa " physical/mental condition; and b. A need to alter the resident's medical treatment a significantly.” 28. The Agency’s surveyor also reviewed the Respondent's |.” policy entitled "Neurological Assessment." Respondent's provides: "The purpose of this procedure is to perform -a vital sign assessment: 1. Upon physician order; 2. When following an un-witnessed fall; 3. Subsequent to a fall with a suspected head dnjury;. 4, When indicated by resident condition. Neurological * - apyesmmente are the -responsibility—of licensed—m ging — ' personnel ; Page 11 of 15 5. Particular attention should be paid to widen ngs pulse pressure (difference between systoli 8 diastolic pressures.) This may be indicative’ of ! increasing intercranial pressure (ICP) ; | 6. Any change in vital/neuro vital signs in’a previously stable resident, should be report jo the physician immediately.” - 29. Respondent intentionally or negligently failed'to - follow its own policies in failing to render appropri and services to Resident #2: Resident #2’s discharge instructions defined a significant change in the resins, physical/mental condition, but Respondent intentionally’ ox | negligently ignored Resident #2's discharge instructi9 18: vand failed to perform any neurological assessment and failea bo: notify any physician until Resident #2’s adult child demanded . notification. | 30. The Agency determined that Respondent inten ionally or negligently had not provided necessary care and services to Resident #2, who had returned from the hospital following: injury, and that Respondent’s failure compromized Resident a aoe ability to maintain or reach his or her highest practicable. physical, mental, and psychosocial well- -being, as defined by an /_._—-gecurateumd-comprehensive-resident-assessment; phen of carer — aa and provision of services. Therefore, the Agency cited Page 12 of 15 +___—¢roper-s;—2010;—and-endingNovember—:6;—2010;—the-date_on_which. ! ee 400.23(8), Fla. Stat. 31. ‘The Agency provided Respondent with the mandatory. ° correction date for this deficient practice of November. 5 WHEREFORE, the Agency seeks to impose an administrative’ pe fine in the amount of $2,500.00 against Respondent, ,a skilled. nursing facility in the State of Florida, pursuant to: §§ 400.23" and 400.102, Florida Statutes. COUNT IT 32. The Agency re-alleges and incorporates patagraphs one. (1) through five (5) and Count I, as if fully set forth ‘in t count. deficiency, Respondent was not in substantial compliance time of the Agency's survey with criteria established. under. Part, ° II of Chapter 400, Florida Statutes, or the rules adoptéd “by:’ he. Agency, a violation subjecting it to assignment of a.donditéonal (9° ’ licensure status under § 400.23, Florida Statutes. WHEREFORE, the Agency intends to assign conditional licenge status to Respondent, a skilled nursing facility in th . State Florida, pursuant to § 400.23, Florida Statutes commenc ig the Agency determined that the violation was corrected. . Page 13 of 15 me DISPLAY OF LICENSE Pursuant to § 400.23(7)(e), Fla. Stat., Respondent shall post - the most current license in a prominent place that is in. ‘clea and unobstructed public view, at or near, the place, wh: : : residents are being admitted to the facility. NOTICE OF RIGHTS Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Tae Statutes, Respondent hag the right to retain, and be’ represented. a by an attorney in this matter. Specific options for . — administrative action are set out in the attached Elect on ‘Of Rights. All requests for hearing shall be made to the Agency. for Health, | Care Administration and delivered to Agency Clerk, Agency: for > Health Care Administration, 2727 Malan Drive, Bldg #3, MS: #3; Tallahassee, FL 32308, whose telephone number is 850- 4120 29630. 0° RESPONDENT IS FURTHER NOTIFIED THAT. THE FATLURE TO REQUEST RY HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT: WILL: RESULY 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 : Dae foregoing has been served by U.S. Certified Mail, Return. Receipt | No. 7004 2890 0000 5526 7261, to Jeanne Deprada, Administrator”. : for Waterman Communities, Inc., @/b/a The Bdgewater at. Materiian | Village, 300 Brookfield Avenue, Mount Dora, Florid 3275 Fa regular U.S. Mail to Richard A, Leigh, Registered Agent :for. Waterman Communities, Inc., d/b/a The Edgewater at Waterman ne Village, 1031 West Morse Blvd., Suite 160, Winter Park... Florida ae 32789, on March ‘27 , 201 + rn s H. Harris ey AsMstant General Coungel -..* Fla. Bar. No. 817775 Agency for Health Care admin 525 Mirror Lake Drive, 330): St.—_Petershburg;—Florida—3370 727-552-1944 (office) te 727-552-1440 (facsimile), Page 14 of 15 Copies furnished to: Jeanne Deprada, Administrator Waterman Communities, Inc., d/b/a The Edgewater at Waterman Village 300 Brookfield Avenue Mount Dora, Florid 32757 (U.S. Certified Mail) Kriste Mennella Field Office Manager Agency for Health Care , Administration : Alachua, Florida 32615- “566 (Interoffice Mail) . James H. Harris, Esq. Agency for Health Care Admin. 525 Mirror Lake Drive, 330H St. Petersburg, FL 33701 (Interoffice). Richard A, Leigh, Registered Agent for waterntian, ant Communities, Inc., d/b/a The . Edgewater at Waterman, villa er 1031 West Morse Blvd. Suite 160, Winter Park, Florida 3278 (U.S. Regular Mail) : Page 15 of 15 ' faterman Communities, Ine.,"' i : /b/a The Edgewater at Waterman| illage 300 Brookfield Avenue Mount: Dora, Florid 32757 4 7HDY, 2850, 0000 S52 zany, |e : Agency for Health C; sates gil. | Leta! Ofte ofthe GeneratCoushit oes A Bat ! Shree ule Dive North GENERA, COUN, | | i (St Petersburg, Florida35701 © APR. 4 9 bie awe ce caeew eg ‘Api jibe te . | a Care idenintatean, | i Wibod Thai da bib Mlb nn 4

Docket for Case No: 11-002094