STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, YS. , CaseNos. 2011002790 (Fine) 2011002791 (Cond.) SOVEREIGN HEALTHCARE OF PORT ORANGE, LLC d/b/a PORT ORANGE NURSING AND REHAB CENTER, Respondent ee ADMINISTRATIVE COMPLAINT. COMES NOW the Agency for Health Care Administration (hereinafter “Agency’’), by and through the undersigned counsel, and files this Administrative Complaint against Sovereign Healthcare of Port Orange, LLC, d/b/a Port Orange Nursing and Rehab Center (hereinafter “Respondent”, pursuant to §§120,569 and 120.57 Florida Statutes (2010), and alleges: NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of $5,000.00 upon Respondent, pursuant to Section 400.23(8), Florida Statutes (2010).The imposition of this fine is based on two (2) Class II deficiencies. The Agency also intends to impose a Conditional rating effective March 2, 2011, pursuant to §400.23(7), Florida Statutes (2010). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to §§ 120.60 and 400,062, Florida Statutes (2010). 2. Venue lies pursuant to Florida Administrative Code R. 28-106.207. Filed May 20, 2011 10:07 AM Division of Administrative Hearings 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 Il, Florida Statutes, and Chapter 59A-4, Florida Administrative Code. 4 Respondent operates a 120-bed nursing home, located at 5600 Victoria Gardens Blvd., Port Orange, Florida 32127, and is licensed as a skilled nursing facility license number 130471000. 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 (Tag N71) 6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 7. That pursuant to Fla, Admin. Code R. 59A-4.109(1), Florida law states: each resident admitted to the nursing home facility shall have a plan of care. The plan of care shall consist of: | (a) Physician’s orders, diagnosis, medical history, physical exam and rehabilitative or restorative potential. (b) A preliminary nursing evaluation with physician’s orders for immediate care, completed. on admission. (c) A complete, comprehensive, accurate and reproducible assessment of each resident’s functional capacity which is standardized in the facility, and is completed within 14 days of the resident’s admission to the facility and every twelve months, thereafter. The assessment shall be: 1. Reviewed no less than once every 3 months, 2. Reviewed promptly after a significant change in the resident’s physical or mental condition, 3. Revised as appropriate to assure the continued accuracy of the assessment. 8. Thaton March 2, 2011, the Agency conducted a complaint investigation (CCR#201 1002096) survey at the Respondent’s facility. 9. Based on staff interviews and record reviews the facility failed to use the nursing admission assessment results to develop interim care plans for residents admitted with pressure sores for 2 of 3 sampled residents (#1, #3) to ensure that the residents would receive the needed care and treatment to the pressure areas resulting in harm to Resident #1. Resident #1 10. A review of the medical record for Resident #1 revealed that the resident was admitted on February 13, 2011 with diagnoses of post surgery repair for a right fractured hip, end stage renal disease and diabetes, Resident #1 was alert and oriented and was ambulating independently at home prior to her recent fall. The discharge plan included for Resident #1 to return home after therapy services, 11. An initial nursing assessment on the Resident Data Set form was performed on February 13, 2011 at 5:30pm, by the LPN (licensed practical nurse) assigned to her care (N1). The initial nursing assessment included a skin assessment. 12. The skin assessment diagram revealed Resident #1 was observed with a reddened area and closed blister to the coccyx, bruises to the hands from IV sites, a surgical wound site to the right hip, scratches to left forearm, and a dialysis catheter to right upper arm. The Braden scale for predicting pressure sore risk was completed on 2/13/11 at the time of admission and was noted to be a 19 which indicated no risk. 13. On February 14, 2011 a registered nurse (N2) signed the Resident Data Set form and noted under sections completed, "reviewed all". 14, The Daily Skilled Nurses' Note that was completed at the time of admission contained documentation that stated "Has closed blister to coccyx area, red. Duoderm applied." 15, A review of the admission physician orders did not include treatment orders for the area to the coccyx. The admission nursing note dated February 13, 2011 revealed the admitting nurse (N1) applied a Duoderm dressing. Further review of the physician orders found there was no order given for the use of Duoderm. 16. A review of the resident's interim care plan dated February 13, 2011 found there was no care plan regarding the pressure area (blister) or potential for skin breakdown. There was an interim care plan for risk of impaired skin with the location marked as right hip. Interventions included pressure reduction mattress, wheelchair cushion if appropriate, keep clean and dry after each incontinent episode, turn and reposition as needed, meds/treatments as ordered by MD, skin integrity documentation initiated, observe for signs/symptoms of infection. It was also noted that the Braden Scale was marked as a 19, indicating no risk. 17. There was no mention of the blister to the coccyx, or that Duoderm had been applied. 18.. On March 2, 2011 at 11:00AM an interview was conducted with the DON. During the interview the DON was asked when treatment was first provided to Resident #1's area on the coceyx. She replied the admitting nurse (N1) made an entry on the initial nursing assessment on February 13, 2011 that Resident #1 was observed with a closed blister to the coccyx and applied a Duoderm dressing. The coccyx wound was not again observed until February 19, 2011. ‘ion 19. The DON also stated the admitting nurse did not include the skin impairment on the interim care plan initiated on February 13, 2011. 20. A-review of the physician progress note dated February 19, 2011 that stated Stage IT coccyx with no other information regarding the wound, and a review of the weekly skin. measurement tool dated February 19, 2011 revealed the following information regarding the coccyx wound on Resident #1; the area was open and measured 7em x 8cm x .25em and. contained slough. This was documented by an LPN (NS). 21. . An interim care plan was not developed at that time to include the coccyx wound as well as care and treatment that was ordered by the physician on February 19, 2011. 22. An initial wound care consult was performed on February 23, 2011 and revealed the following: The coccyx wound is necrotic and probably contaminated, it is in close proximity to anal area, the wound extends from the sacrococcygeal junction to the perianal area, and it is uniformly necrotic and sloughy and has heavy thick serous and purulent exudate. The wound is Stage 3 and measured 5.5cm x 2.8em x 0.7em. Wound had 80% yellow slough with Sem erythema and 2cm maceration. The wound was debrided of tissue down to and including muscle extending to viable tissue. Despite the continued deterioration of the coccyx wound (Stage II on February 19, 2011 to a Stage III on February 23, 2011) which required sharp debridement, the facility failed to develop an interim care plan. 23. Avreview of the focus meeting notes for Resident #1 dated February 24, 2011 revealed the following: The resident was admitted with a closed blister to the coccyx and was assessed on February 23, 2011 by the wound care physician; a new treatment was ordered and will continue to monitor. A care plan to address the coccyx wound was not initiated until March 1, 2011 when the comprehensive assessment and minimum data set was completed. Resident #3 "24. — Resident #3 was admitted to the facility on February 21, 2011 with diagnosis of post fractured hip, An initial nursing assessment was performed on February 21, 2011 and revealed a small, dark closed area to right buttock measuring 1/2cm x 1/4cm. A Braden Scale was performed with a score of 16 (15-18 indicates resident at risk for skin breakdown). Resident #3 was refered to the wound care specialist and was seen on February 23, 2011. 25, The wound care physician note dated February 23, 2011 wrote in the Wound Description area on his consultation form the following: Location - pelvis buttocks right medial; etiology - pressure; stage - unstagable; duration - chronic; size (Lx WxD) - 2.0 X 1.4 X 0.5; Undermining - none; exudate - scant; % of yellow slough - 15%; % of black eschat - 80%; % of granulation tissue - 25%. Periwound description - odor- none; erythema - 2cm surrounding; maceration - present. Procedural treatment identified: Anesthesia 20% Benzocaine - Excisional debridement of tissue down to & including subcutaneous using curette extending to viable tissue. 26. On February 23, 2011 the wound care physician made the following recommendations: The wound to be irrigated with wound cleanser. Sure prep painted on and around the wound. The prep pad is left in situ and covered by a boardered gauze. Offload Q 2 hours - Use pillows or wedges for positioning. 27. A review of the interim care plan dated February 21, 2011 did not address the pressure sore or the potential for further skin breakdown. On February 23, 2011 Resident #3 underwent debridement of the right buttock wound. The wound care physician gave the staff specific recommendations for care and treatment of the wound; however, an interim care plan was not initiated. 28. Acare plan to address the pressure sore was not initiated until March 1, 2011 after a full assessment and minimum data set had been completed. | 29. Class “II” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines directly threaten the physical or emotional health, safety, or security of the clients, other than class I violations. The agency shall impose an administrative fine as provided by law for a cited class II violation, A fine shall be levied notwithstanding the correction of the violation. §408.813(2)(b), Florida Statutes (2010) 30, 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. 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 licensure inspection or any inspection or complaint investigation since the last licensure inspection. A fine shall be levied notwithstanding the correction of the deficiency. §400.23(8)(b), Florida Statutes (2010) 31. The Agency cited Respondent for an isolated Class Ii deficiency. 32, The Agency gave a mandatory correction date of this deficiency of April 2, 2011. WHEREFORE, the Agency intends to impose an administrative fine in the amount of $2,500 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §400.23(8)(b), Florida Statutes (2010), COUNT II (Tag N216) 33. _ The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein. 34. That pursuant to §400.102(1), Florida Statutes (2010), Florida law states: 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. 35. That on March 2, 2011, the Agency conducted a complaint investigation (CCR#2011002096) survey at the Respondent’s facility. 36. Based on observation, record review and staff interviews, the facility failed to have a system in place to timely identify, assess and treat pressure sores and to have measures in place to promote healing of existing pressure sores for 1 of 3 sampled residents. (Resident #1) 37. This failure resulted in harm to Resident #1 who had a decline in the pressure sore area from a closed blister at the time of admission on February 13, 2011 to a Stage III on February 19, 2011, that the facility was unaware of until a dressing was removed 6 days after application. 38. Areview of Resident #1's medical record revealed that Resident #1 was admitted on February 13, 2011 with diagnoses of post surgery for a right fractured hip, end stage renal disease and diabetes. Resident #1 was alert and oriented and the discharge plan was for Resident #1 to return home after therapy services. 39. A review in the medical record of the initial nursing assessment completed on the Resident Data Set form was performed on February 13, 2011 at 5:30pm by the LPN (licensed practical nurse) assigned to her care (N1). The initial assessment included a skin assessment. The skin assessment revealed Resident #1 was observed with a reddened area and closed blister to the coccyx, bruises to hands from IV sites, a surgical site to the right hip, scratches to left forearm, and a dialysis catheter to right upper arm. The Braden Scale for predicting pressure sore risk was completed on February 13, 2011 at the time of admission and was noted to be a 19 which indicated no risk. 40. A review of the facility wound care protocol for partial thickness wound/stage II pressure ulcer revealed that the protocol for trunk or extremities included to cleanse wourd with wound cleanser, pat dry and apply protective barrier wipe to intact skin around wound, The protocol noted for sacral/coccyx wounds; "apply foam with silicone dressing. Change dressing daily" Review of the admission nursing note in the resident's medical record dated February 13, 2011 at 5:30pm revealed the admitting nurse (N1) documented the blister to the coccyx and applied a Duoderm dressing. 41. The facility policy is that an RN is to review and sign the initial nursing assessment when done by an LPN. On February 14, 2011 a registered nurse (N2) signed the Resident Data Set form and noted under sections completed, "reviewed all". 42. The director of nursing (DON) was asked on 3/2/11 at 10am if after the initial assessment was reviewed by the RN was the skin impairment reported to the wound nurse, DON and addressed in the care plan. She stated, "no". 43, A review of the admission physician orders did not include treatment orders for the area to the coccyx. Further review of the physician orders found there was no order given for the use of Duoderm. An interview conducted with the DON on March 2, 2011 at 10:05am verified there was no order obtained. The DON was asked what was the facility policy regarding documenting wounds discovered upon admission or newly acquired wounds in the facility. She stated the wounds should be assessed, measured and reported to the physician for appropriate treatment. 44, A further review of the medical record revealed that the resident's physician saw the resident on February 19, 2011 and documented a Stage II on the coccyx. There was no documentation of the size or appearance of the wound by the physician on this progress note, At the bottom of the page in the area noted as plan, was written Santyl to coccyx, check prealbumin. This was signed and dated by the physician as February 22,2011. A review of the Weekly Skin Measurement Tool dated February 19, 2011 noted open area, buttocks/coccyx, length 7em, width 8cem, depth below (<) .25cm(non-measurable= <,25cm). It also noted slough. Under other is noted 1 1/2 cm x 5 cm brownish slough in middle of open area. This was signed by a Licensed Practical Nurse (LPN) (N5). 45. A xeview of the physician order sheet from the medical record revealed that on February 19, 2011 an order was written by (N5) who had documented the appearance and size of the wound. The order stated cleanse open area on coccyx and buttocks with wound cleanser, apply hydrogel, puracol and boarder gauze. Change daily and PRN (as needed) until resolved. This order was signed by the physician on February 22, 2011, 46. On February 21, 2011 another physician order was written that stated coccyx - change treatment order to clean with wound cleaner, skin prep peri wound apply Santyl and cover with border gauze. Change every other day and as needed. This order was also signed by the physician on February 22, 2011. No order was found to have lab work done for a pre albumin. An order had been written February 17, 2011 for the resident to receive Pro-Stat 101 for low albumin 47. On March 2, 2011 at 10:05am, the DON explained the nurse is to complete a Weekly Skin Measurement Tool to record the specifics of the wounds. When asked if the nurse had completed the weekly skin measurement tool for Resident #1 at the time of admission she stated "no". The DON was asked if the physician had been notified of Resident #1's skin condition at admission. She stated there was no documentation to indicate the physician had been notified, 48. A review of the resident's interim care plan dated February 13, 2011 found there was no care plan noting the pressure area (blister) or potential for skin breakdown to this area. There was an initial interim care plan for risk of impaired skin with the location marked as right hip. Interventions included pressure reduction mattress, wheelchair cushion if appropriate, keep clean and dry after each incontinent episode, turn and reposition as needed, meds/treatments as ordered by MD, skin integrity documentation initiated, observe for signs/symptoms of infection. It was also noted on this interim care plan that the Braden Scale used for predicting pressure sore risk was marked as a 19, indicating no risk. 49. A review of the treatment records for February 2011 for Resident #1 revealed that there were no treatment orders for the coccyx area from February 13 through February 19, 2011. The nursing documentation from February 13 through February 19 did not include any further assessment of impaired skin to the coccyx area or that a Duoderm dressing was present. There was no documentation that the Duoderm dressing was removed and the area inspected until February 19, 2011. 50. An interview was conducted with the DON on March 2, 2011 at 10:10am. When asked if the nurses date the Duoderm dressing when applied she stated, "no". When asked how often, should the Duoderm be changed she said usually every three days. When asked how the staff would know how long the dressing was in place, she said the treatment record would indicate the last date applied. The DON said there would not be any other way to verify the date the Duoderm was applied. 51. On March 2, 2011 at 11:00 am an interview was conducted with the DON. During the interview the DON was asked when treatment was first provided to Resident #1's pressure area on the coccyx. She replied the admitting nurse (N1) made an entry on the initial nursing assessment on February 13, 2011 that Resident #1 was observed with a closed blister to the coccyx and applied a Duoderm dressing. The coccyx wound was not again observed until February 19, 2011. When asked why the wound had not been assessed for six days she stated the facility was unaware that Resident #1 had skin impairment to the coccyx. She also stated that the admitting nurse (N1) had not informed the supervisor when the resident was admitted and the information was not passed. on at report. The DON also said the admitting nurse did not include the skin impairment on the initial interim care plan initiated on February ‘13, 2011. 52, A review of the nursing note dated February 20, 2011 at 8am revealed that a dressing change had been performed. There was no documentation that a treatment order had been obtained, that the previous Duoderm dressing had been removed or the appearance of the wound at the time of the dressing change. 53. Arrangements were made for the wound care specialist to see Resident #1 on his next visit on February 23, 2011. 54. An interview was conducted with the wound nurse (WN) on March 2, 2011 at 9:30am. During the interview she was asked what her duties were as the wound nurse. She stated she did not perform the treatments; the treatments for all residents were performed by the nurses assigned to those residents. Her duties included: making rounds with the wound care physician every Wednesday and tracking the measurements of the wounds. She prepared the weekly wound report that was used at the weekly Focus meetings. She stated she did not perform the weekly measurements of wounds because that was done by the staff nurses. Also, since she is an LPN she is not allowed to assess wounds; therefore, she does not make wound treatment recommendations. She stated that a recent change in her duties now included reviewing the weekly skin assessment records to ensure they are completed for all residents. When asked when she was first notified of the coccyx wound on Resident #1 she stated February 19, 2011 and that she visualized the wound for the first time on February 23, 2011 when the wound care specialist examined and treated the wound. 55, An initial wound care consult was performed on February 23, 2011 and revealed the following: The coccyx wound is necrotic and probably contaminated, ( it was noted that the resident did have episodes of incontinence), it is in close proximity to anal area, the wound extends from the sacrococcygeal junction to the perianal area, and it is uniformly necrotic and sloughy and has heavy thick serous and purulent exudate. The wound is Stage ITT and measured 5.5em x 2.8cm x 0.7em (approximately 2 inches by one inch and 1/4 inches deep). Wound had 80% yellow slough (dead tissue separating from live tissue) with 5 cm erythema (reddened) and 2 cm maceration (on tissue). The wound was debrided of tissue down to and including muscle extending to viable tissue. 56. Class “II” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines directly threaten the physical or emotional health, safety, or security of the clients, other than class I violations. The agency shall impose an administrative fine as provided by law for a cited class I] violation. A fine shall be levied notwithstanding the correction of the violation. §408.813(2)(b), Florida Statutes (2010) 57. 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. 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 licensure inspection or any inspection or complaint investigation since the last licensure inspection. A fine shall be levied notwithstanding the correction of the deficiency. §400.23(8)(b), Florida Statutes (2010) 58. The Agency cited Respondent for an isolated Class IT deficiency. 59, The Agency gave a mandatory correction date of this deficiency of April 2, 2011. WHEREFORE, the Agency intends to impose an administrative fine in the anount of $2,500 against Respondent, a skilled nursing facility in the State of Florida, pursuant to §400,23(8)(b), Florida Statutes (2010). COUNT IH 60. The Agency re-alleges and incorporates paragraph one (1) through five (5) of this Complaint as if fully set forth herein. 61. The Agency re-alleges and incorporates Count I through II of this Complaint as if fully set forth herein. 62. Based upon Respondent’s cited State Class II deficiencies, it was not in substantial compliance at the time of the survey with criteria established under Part I 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 (2010). 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 (2010) commencing March 2, 2011. 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 Counts I through TIT; (B) Recommend administrative fines against Respondent in the amount of $5,000; (C) Impose a conditional license commencing March 2, 2011; (D) Assess attorney’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 in this matter. RESPONDENT IS 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. 15 Respectfully submitted this / f day of April, 2011 deco D. Carlton Enfinger, IIa. Fla. Bar. No. 793450 Agency for Health 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 412-3640: 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. 7009 0960 0000 3708 3437 to: Facility Administrator Warnell Ray McCall, Port Orange Nursing and Rehab Center, 5600 Victoria Gardens Blvd., Port Orange, Florida 32127 and by U.S. Mail to Registered Agent National Corporate Research, Ltd. Inc,, 515 E. Park Avenue, Tallahassee, Florida 32301 on April ff, 2011: Ao D. Cul Enfinger Copy furnished to: Rob Dickson, FOM 16 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION RICK SCOTT GOVERNOR April 12, 2011 PORT ORANGE NURSING AND REHAB CENTER $600 VICTORIA GARDENS BLVD PORT ORANGE, FL 32127 Dear Administrator: ELIZABETH DUDEK SECRETARY The: attached license with Certificate #16704 is being issued for the operation of your facility, Please review it thoroughly to ensure that all information is correct and consistent with your records. If etrors or omissions are noted, please make corrections on a copy and mail to: Agency for Health Care Administration Long Term Care Section, Mail Stop #33 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308 Issued for status change to Conditional. Sincerely, Juluathorspeon Tracey Weatherspoon Agency for Health Care Administration Division of Health Quality Assurance Enclosure ce: Medicaid Contract Management FLORIDA COMPARE CARE Health Care In the Sunshine fh rin tlonecamparecare go 2727 Mahan Drive, MS#33 Tallahassee, Florida 32308 Visit AHCA online at ahca.myflorida.com T10Z/0€/60 ‘ALVG NOILVUWdxa T107/Z0/€0 ‘LV FALLOddda AONVHO SOIVIS Sad 071 *TIVLOL LTIZE Td ‘SONVUO LAOd GAT SNACAVD VIMOLOIA 009 UWALNAD aVHTY GNV ONISUAN FONVUO Laod -SULMOTIOJ ot oyesodo 0} pezLoyNe st eosueoT] au} se pure ‘somreys epuOLy ‘T] wed ‘OOP Jardeyo ur pezLoU;ne “uoRensTUTUIpy a7) THIPeH 104 Anuesy “epulopy Jo areig om Aq poidope suore|ngoz pure sopnt otf HIM paryduzos sey DTT ‘AONVYO LYOd 40 AUVOHLTVaH NOITYSAOS 7H ULITFHOS 0} SE STL qINOH ONISMON FONVUNASSV ALITVNO HLTVSH AO NOISIAIG NOLLVYULLSININGYV FuaVvD HLIV AH WOT AONADV VPLIOL] JO 9381S POLST *# ALVOMITaO } ) in ime ar 1 m co Q Postage m Certitied Fee oO Postmark o Return Recelpt Fes o (Endorsement Required) © Restricted Delivery Fee } (Endorsement Required) ) oO } =D otal Postage & Fi r ge & Fees ja rc Cont e Gales ' Qe . | SIA2? nl USPS - Lrack & Contirm Page | ot 1 BASIE. to Track & Confirm FAQs Track & Confirm Search Results Label/Receipt Number: 7009 0960 0000 3708 3437 perme cement Service(s): Certified Mail™ Track & Contin Status: Processed through Sort Facility Your item was processed through and left our DAYTONA BEACH, FL 32114 facility on April 21, 2011 at 4:30 am. 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Docket for Case No: 11-002579