STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLOIUDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs. AHCA NO. 20110 0 7 83.2

INNOVATIVE HEALTH CARE PROPERTIES, LLC d/b/a SUMMER BROOK HEALTH CARE 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 Innovative Health Care Properties, LLC, d/b/a Summer Brook Health Care Center (hereinafter "Respondent'), pursuant to§§120.569 and 120.57 Florida Statutes (2011), and alleges:

NATURE OF THE ACTION

This is an action to impose an administrative fine in the amount of $15,000.00 based upon Respondent pursuant to Section 400.23(8)(a), Florida Statutes (2011) and a survey fee of

$6,000 pursuant to Section 400.19(3), Florida Statutes (2011). The imposition of this fine is based on one Class I deficiency. The Agency also intends to impose a Conditional rating effective June 10,2011 and ending July 13, 2011, pursuant to§ 400.23(7), Florida Statutes

(2011).

JURISDICTION AND VENUE

1. The Agency has jurisdiction pursuant to §§ 120.60 and 400.062, Florida Statutes (2011).

   
   

   . 1

   
   

   Filed August 19, 2011 2:25 PM Division of Administrative Hearings

   
   

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 120-bed nursing home, located at 5377 Moncrief Road, Jacksonville, Florida 32209, and is licensed as a skilled nursing facility license number 1132096.

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 N0ll0}

   
   

6. The Agency re-alleges and incorporates paragraphs one (1) through five (5), as if fully set forth herein.

7. That pursuant to §400.141(1)(h), Florida Statutes (2011), Florida law states, every licensed facility shall comply with all applicable standards and rules of the agency and shall: Maintain the facility premises and equipment and conduct its operations in a safe and sanitary manner.

8. That pursuant to Fla. Admin. Code R. 59A-4.122(1), Florida law states, The facility shall

   
   

   provide a safe, clean, comfortable, and homelike environment, which allows the resident to use his or her personal belongings to the extent possible.

9. That from June 6, 2011 through June 10, 2011, the Agency conducted an unannounced licensure survey at the Respondent's facility.

I 0. · Based on observation, review of the facility's policy and procedures, clinical records and facility provided documentation and interviews with the dietary manager (DM), kitchen employees, the service technicians, and the maintenance director, that the facility failed to maintain essential mechanical equipment located in the kitchen in a safe operating condition and placed the residents of the facility at risk for foodborne illness and infectious diseases.

1. A sewage backup occurred from three kitchen floor drains, which was an imminent health hazard and the facility did not immediately cease food service operations to address this and prevent contamination of food, equipment, and single-service items from serious disease causing microorganisms, such as Escherichia coli.

2. This situation resulted in the regulatory agency closing the kitchen until appropriate corrective actions were taken.

3. Additionally, the facility's dish washing machine was not adequately washing and sanitizing multi-use dishes and equipment for over a month and staff was not adequately trained for the dish washing machine operation, and there was a lack of managerial oversight to ensure that the dish washing machine was properly operating and that alternate methods were used when problems were identified.

4. These circumstances presented a widespread, serious and immediate threat to the health of 113 of 116 residents who ate in this facility due to the high potential for food borne illness.

5. Nursing home residents are considered a highly susceptible population because they are more likely than other people in the general population to experience foodbome disease because they are older adults and/or immune-compromised. Foodborne illness may have serious medical consequences in nursing home residents.

   
   

6. In addition, the facility failed to ensure potentially hazardous frozen food was kept solidly frozen, did not ensure that the three compartment sink was equipped with hot water, and did not maintain other essential kitchen equipment in safe working order.

7. The facility's dish washing machine was not adequately washing and sanitizing multi-use dishes and equipment for over a month and staff was not adequately trained for the dish machine operation, and there was a lack of managerial oversight to ensure that the dish machine was proper!y operating. This situation presented an immediate serious threat to the health of the nursing home residents due to the high potential for foodbome illness.

8. An observation of the facility's kitchen on 6/6/11 at 9:30 AM during the initial tour revealed the dish washing machine was in operation. Two kitchen employees were stacking dirty dishes in wash racks and preparing to run them through the dish washing machine.

9. An observation of two separate trials at that time, revealed the rinse cycle did not reach the manufacturer's recommendation of at least 180 degrees F (the dish washing machine used hot water to sanitize). The water in the rinse cycle reached a temperature of 170 and 175 degrees F respectively.

10. An observation of the "clean" dishes exiting.the dish washing machine on 6/6/11 at 9:35 AM revealed they were covered with a white film, and remaining food debris was noted on several dinner plates.

11. The storage and wash racks that contained the clean dinnerware, cups, domes, serving trays, silverware, and other food service equipment were also visibly soiled and covered with a white film.

12. An interview with the dietary manager (DM) on 6/6/11 at 9:35 AM confirmed the dish washing machine had not functioned effectively since 5/10/11. She stated the service technician

    
    

    worked on the machine on 5/10/1 I, but it continued to malfunction. The water temperatures remained s11bstandard.

13. Hoviever, a review of the water temperature logs located in the dish room revealed staff had utilized the dish machine since 4/20/1 I, even though the machine was not functioning properly.

14. A review of the service technician's invoice dated 5/10/11 confirmed the service technician viorked on the dish washing machine and he wrote that the booster control (that heats the water) Vias bad and he had to order some parts.

15. Hoviever, the kitchen staff continued using the dish machine, rather than implementing an alternative method to sanitize multi-use dishes and equipment or use single-use dishes.

16. An interview with the two kitchen employees who were operating the dish washing machine at 9:35 AM on 6/6/11 revealed they were unaware of the required minimum water temperatures for the wash and rinse cycles

17. They also stated they did not know why the temperature logs reflected a range of te!llperatures rather the highest single reading.

18. An interview with the DM on 6/6/11 at 9:35 AM confirmed that staff documented a range of temperatures rather than a single reading.

19. The DM was unable to explain why staff recorded the temperatures using a range of temperatures, or why they were documenting three different temperatures on the log, rather than just the wash and rinse cycle since the dish machine was only equipped with a wash and rinse temperature gauge.

20. A review of the temperature logs from 4/20/1 I through 6/6/1 I (47 days), revealed the kitchen staff should have taken and recorded the water temperatures in the dish washing machine at least 141 times, per their policy and procedure.

21. A review of the temperature log confirmed the water temperatures had not reached a safe wash temperature of at least 150 degrees F, 71 out of the 141 times, or about 50% of the time.

22. A review of the water temperature log revealed the temperature of the rinse water was either not recorded or did not reach a safe sanitizing temperature of 180 degrees F 135 out of 141 times.

23. The water temperature reached 180 degrees F only six times since 4/20/11 or less than 5% of the time. The documentation revealed the water temperature in the rinse cycle ranged from I I 9 to 179 degrees F.

24. • A review of the service technician's second invoice dated 6/7/11 revealed the temperature of the rinse water in the dish machine had only reached a temperature of 177 degrees F. The service technician adjusted the temperature controls and he found that the standpipe lower flow drain had clogged.

25. A review of the facility's preplanned menus revealed that during the week of 6/6/1 I -

    
    

    6/11/11, the facility prepared food with ingredients usually containing hazardous disease-causing microorganisms that could contribute to food borne illness.

26. The menu items prepared by the facility included ingredients such raw chicken, pork, fish, and ground beef which usually contain hazardous disease-causing microorganisms such as Salmonella spp, Campylobacter jejuni, C/ostridium perfringens, Escherichia coli Ol 57:H7, and Listeria Monocytogenes.

    
    

    
    

27. When the dishwasher malfunctioned and did not clean or sanitize the dishes effectively from 4/20/11 through 6/6/11, the nursing home residents, which are characterized as a highly susceptible population, consumed food on multi-use dishes possibly contaminated with these hazardous microorganisms.

28. The facility failed to ensure the freezer was operating properly and potentially hazardous frozen food was not kept solidly frozen.

29. An observation of the freezer on 6/6/11 at 9:50 AM revealed there was a liquid dripping from the fan and landing on cardboard boxes. The boxes contained food and they were open. The floors were wet and ice was observed on the boxes, walls, and floors.

30. The internal temperature gauge read 10 degrees F and the individual servings of ice cream had begun to melt and felt scift to the touch.

31. An interview with the repair technician on 6/8/11 at 8:05 AM confinned the condenser fan was broken which is why the liquid was dripping and the ice cream had begun to melt.

32. He replaced the fan on 6/7/11 after surveyor intervention.

    
    

33. The walk-in refrigerator was not maintained in a safe operating condition that created a potential for cross-contamination.

34. An observation of the walk-in refrigerator on 6/6/11 at 9:48 AM revealed the air curtain was missing the center strips and the outside strips were wrapped around the food shelves.

35. The bottom of the fly curtain was covered with a dark, sticky, tar like substance and was in contact with the raw chicken that was stored on the lowest shelf in the refrigerator.

36. On 6/7/11 at 11:30 AM staff was observed carrying a tray of uncovered beverages out of the walk-in refrigerator. The tray contained approximately 20 individual servings of water that was intended for the residents. As staff walked through the refrigerator door, the soiled air

    
    

    
    

    curtain brushed the top edges of the water cups, which created a potential for cross­ contamination.

37. The facility did not ensure that the three compartment sink was equipped with hot water.

    
    

38. An observation of the three-compartment sink on 6/7/11 at 11:30 AM revealed staff had filled all three compartments with water and had begun to wash the pots and pans.

39. The water in the first sink, the wash water, was cold when touched and filled with food debris. The soapsuds were orange in color.

40. The water in the second sink, the rinse water, and the water in the third sink, the sanitizing water, was also cold when touched. Staff stated the water coming from the hot water faucet was too cold.

41. An interview with two kitchen employees on.6/6/11 at 9:45 AM and again at 11:30 AM confirmed that neither employee understood what the minimum water temperature should be. ·

42. A review of the policy and procedure for washing dishes in the three-compartment sink revealed the water in the wash sink was to be 110 degrees F, the temperature of the rinse water was to be 120 degrees F and the third sink, the sanitizing water, was to be 75 degrees F.

43. . An interview with the maintenance director and the plumber on 6/9/11 at 3:00 PM

    
    

    confirmed that the water in the three-compartment sink was too cold because of the water heater temperature setting.

44. The plumber adjusted the temperature of the water at that time and it recorded at 130 degrees F.

45. The facility did not maintain the kitchen equipment in safe operating condition.

    
    

46. An observation of the gas stove on 6/6/11 at 9:45 AM revealed it was missing the bottom kick plate and all of the burner elements were exposed.

47. In addition, an observation of the kitchen on 6/6/11 at 9:45 AM, revealed a magnetic utensil-holding strip that was attached to the wall above the three-compaitment sink. Attached to the magnetic strip was several knives and both the strip and the knives were visibly soiled. One of the hanging knives was cracked and missing large pieces of metal.

48. Staff stated, at that time, that because the facility did not possess a meat slicer, they used the knives to slice cooked meat. Consequently, the sliced meat could have contained metal shavings from the cracked knife.

49. Class "I" violations are defined ins. 408.813. The agency shall impose an administrative fine for a cited class I violation in the amount of$ I0,000 for each violation and such ainount shall be doubled if there has bee aprevious class II citation since the last licensure inspection.

    §400.23(8)(a), Florida Statutes

    
    

50. Class"!" 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 present an imminent danger to the clients of the provider or a substantial probability that death or serious

physical or emotional harm would result therefrom. The condition or practice constituting a class I violation shall be abated or eliminated within 24 hours, unless a fixed period, as determined by the agency, is required for correction. 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.

6 I. The Agency gave a mandatory correction date of this deficiency of June I 0, 2011.

WHEREFORE, the Agency intends to impose an administrative fine in the amount of

$15,000 against Respondent, a skilled nursing facility in the State of Florida, pursuant to 400.23(8)(a), Florida Statutes (201 I).

COUNT II

1. The Agency re-alleges and incorporates paragraph one (1) through five (5) of this Complaint as if fully set forth herein.

2. The Agency re-alleges and incorporates Count I of this Complaint as if fully set forth herein.

3. Based upon Respondent's cited State Class I 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 (2011).

   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 (2011) commencing June I 0, 2011 and ending July 13, 2011.

   COUNTIII

   
   

4. The Agency re-alleges and incorporates paragraphs one (1) through five (5) and Count I of this complaint as if fully set forth herein.

5. Respondent has been cited for one (1) State Class I deficiency and therefore is subject to a six (6) month survey cycle for a period of two years and a survey fee of six thousand dollars ($6,000) pursuant to Section 400.19(3), Florida Statutes (2011).

   WHEREFORE, the Agency intends to impose a six (6) month survey cycle for a period of two years and impose a survey fee in the amount of six thousand dollars ($6,000.00) against Respondent, a skilled nursing facility in the State of Florida, pursuant to Section 400.19(3), Florida Statutes (2011).

   
   

   CLAIM FOR RELIEF

   
   

   WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court:

   1. Make factual and legal findings in favor of the Agency on Count I;

      
      

   2. Recommend administrative fines against Respondent in the amount of $15,000;

      
      

   3. Impose a conditional license commencing June 10, 2011 and ending July 13, 2011;

      
      

   4. Grant a six month survey cycle for a period of2 years and a sw-vey fee of $6,000; (E)Assess attorney's fees and costs; and

(F) Grant all other general and equitable relief allowed by law.

D. Carlton Enfinger,

Fl. Bar No. 793450

Office of the General Counsel

Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308-5407

Telephone: 850-412-3640

CERTIFICATE OF,SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by

Center, 5377 Moncrief Road, Jacksonville, by U.S.

ey, 2333 Hansen Lane, Ste 4, Tallahassee, Florida

Park Avenue North, Winter Park, Florida 32789 on

r

.

,

U.S. Certified Mail, Return Receipt No. 7009 1010 0000 9715 1722 to Dewayne Harvey,. Administrator, Summer Brook Health Care

Mail to Registered Agent Dewayne Harv 32310 and by email to Jonathan Grout, 2160 this _[/_ day of August, 20I I :

Copy:

Rob Dickson, FOM

11

Docket for Case No: 11-004241