: STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs, Case No. 2013011707 DELRAY GROUP, LLC d/b/a LAKE VIEW CARE CENTER AT DELRAY, 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 DELRAY GROUP, LLC d/b/a LAKE VIEW CARE CENTER AT DELRAY (hereinafter “Respondent”), pursuant to Sections 120,569 and 120.57 Florida Statutes (2013), and alleges: NATURE OF THE ACTION “This is an action against a nursing home facility to impose an administrative fine of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500.00) pursuant to Section 400.231 (8)(b), Florida Statutes (2013), based upon one (1) Class II deficiency and to assign conditional licensure status beginning on September 26, 2013, and ending on October 26, 2013, pursuant to Section 400.23(7)(b), Florida Statutes (2013). The original certificate for the conditional license is attached as Exhibit A and is incorporated by reference. The original certificate for the standard license is attached as Exhibit B and is incorporated by reference. JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2013). 2. The Agency has jurisdiction over the Respondent pursuant to Section 20.42, Chapter 120, and Chapter 400, Part II, Florida Statutes (2013). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the regulatory authority responsible for the licensure of nursing home facilities and the enforcement of all appli¢able federal and state statutes, regulations and rules governing nursing home facilities pursuant to Chapter 400, Part II, Florida Statutes (2013) and Chapter 59A-4, Florida Administrative Code. The Agency is authorized to deny, suspend, or revoke a license, and impose administrative fines pursuant to Sections 400.121 and 400.23,-Florida Statutes (2013); assign a conditional license pursuant to Section 400.23(7), Florida Statutes (2013); and assess costs related to the investigation and prosecution of this case pursuant to Section 400.121, Florida Statutes (2013). 5. Respondent operates a 120-bed nursing home located at 5430 Linton Boulevard, Delray Beach, Florida 33484, and is licensed as a nursing home facility, license number 12300962. Respondent was at all times material hereto, a licensed nursing home facility under the licensing authority of the Agency, and was required to comply with all applicable state rules, regulations and statutes, COUNT I The Respondent Failed To Ensure The Right To Receive Adequate And Appropriate Health : Care in Violation of Section 400.022(1)(), Florida Statutes (2013) 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). 7. Pursuant to Florida law, 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; 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. Section 400.022(1)(), Florida Statutes (2013). 8. On or about September 23, 2013 through September 26, 2013, the Agency conducted a Re- _ licensure Survey of the Respondent’s facility. 9. Based on observation, record review and staff interview, the facility failed to: 1.) Ensure the administration of a Fentanyl transdermal patch was in place for effective pain management for one (1) of one (1) sampled residents, specifically Resident number one hundred seventy six (176), ” for pain recognition and management out of twenty eight (28) sampled residents; and 2.) Failure to ensure nutritional recommendations for wound healing was implemented for one (1) of one (1) sampled residents, specifically Resident number one hundred forty four (144), for Pressure Ulcers out of twenty eight (28) sampled residents. 10. A record review revealed Resident number one hundred seventy six (176) was admitted on June 22, 2013 with a medical history io include Peripheral Vascular Disease, Diabetes Mellitus and wound to lower extremities, The Admission Skin Assessment documented black necrotic wounds to bilateral heels. 11. | The most recent wound assessment on September 19, 2013 documented a diabetic foot wound to the left second toe, 100% Eschar measuring 2.0 cm x 1.4 cm. Pressure wound unstageable to right heel measuring 14.3 om x 6.5 cm 85% Slough, 5% granulation and 10% Eschar. Pressure wound left heel unstageable 2.7 cm x 5.0 cm 100 % Eschar. The most recent Minimum Data Set assessment on August 19, 2013 revealed the resident was unable to answer the - pain assessment interview. 12. On September 12, 2013, the residents’ physician ordered a Fentanyl Patch 25 meg /hour to be administered every seventy two (72) hours for pain. On September 16, 2013, the pain medication dose was increased to Fentanyl Patch 50 mog/hour, every seventy two (72) hours due to increased pain intensity. Additional pain medication was ordered for Vicodin 7.5 mg/500 mg, by mouth to be administered every six (6) hours, as needed for pain. 13. The resident was observed on September 24, 2013 at 01:45 p.m. in bed, asleep. On September 24, 2013 at 2:30 p.m.,, the resident was yelling, restless and attempting to hit the nurse when she tried to reposition the resident’s legs. The resident appeared to be in pain. At the time, upon inquiry about the resident's pain management, the nurse states the resident was receiving a Fentanyl Patch, every seventy two (72) hours for pain. The nurse was asked to locate the Fentanyl patch on the resident. Upon observation, the pain patch was not observed on the resident's chest or back. The nurse stated she would check the electronic Medication Administration Record for the administration site. The Medication Administration Record documented Fentanyl 50 mcg/Hr. was administered on September 21, 2013 at 5:00 p.m. However, no administration site was . documented. 14. The resident was observed on September 24, 2013 at 3:20 p-m. with the Nurse Manager, a Licensed Nurse and two (2) certified nursing assistants, The resident's clothing was removed to observe the resident’s skin. The transdermal pain patch was not observed on the resident or in the bed. The resident was screaming continuously when repositioned in the bed. 15. A review of the medication administration records revealed the Fentanyl Patch 50 meg/hour was administered on September 21, 2013 at 5:00 p.m. The resident was not monitored to ensure the pain medication transdermal patch was administered as ordered. During an interview with a Certified Nursing Assistant on September 25, 2013 at 1:30 p.ta., she stated the resident yelled continuously during care. A further record review revealed the Hospice care was initiated on September 18, 2013. An initial plan of care for pain was initiated on September 18, 2013. Goal: Pain was controlled with appropriate analgesics. Interventions: Assess effectiveness of pain relief measures. 16. Inan interview with a Hospice physician on September 25, 2013 at 9:40 a.m., the physician stated she was called to evaluate the resident for pain management. The physician stated, the 4 resident mumbled about pain in his/her legs. The physician stated the current pain medications are not effective and will discontinue the Fentanyl Patch and start Morphine 5 mg every four (4) hours. The physician also states the resident needs 1:1 supervision for pain management. 17. On September 26, 2013 at 10:05 a.m., the resident was calm, cooperative with care and smiling. The hospice nurse in the room providing care reported the resident was much improved today after the administration of the morphine, 18. A review of the clinical record for Resident number one hundred forty four (144) revealed an admission of February 10, 2013 and a readmission of June 18, 2013. The resident's diagnoses included Chronic Airway Obstruction, Asthma, Airial Fibrillation, Transient Ischemic Attack (TIA)/(stroke), Fall, Dysphagia, High Cholesterol, Anxiety, Vertigo, Cellulitis leg, Pain in joint, Constipation, Angina, and Congestive Heart Failure. 19. A review of the wound care notes revealed the resident sustained an unstageable wound to the right heel..On September 3, 2013, the nursing notes documented discoloration to right lateral heel, skin/wound assessment rendered at this time, right lateral heel noted with purple/red discoloration 1.6x3.5x.area is soft to touch; wound margins undefined left lower extremity (LLE); noted with 3+edema. 20. The Diet Tech reviewed the nutritional status of the resident on September 3, 2013. The Diet Tech documented a note to include the right heel deep tissue with 3+ edema; had a good appetite, no supplement, and recommended a Multivitamin daily to help meet needs. 21. A review of the physician orders revealed; treatment in place, but there was no order for a Multivitamin. A review of the Medication Administration Record on September 24, 2013 at 2:20 p.m. with the Mauve unit nurse revealed there was no ordered Multivitamin. 22, An interview with the unit manager on September 24, 2013 at 2:20 p.m. revealed the Diet Tech should have put the information into the system so mursing could verify the order for the. Multivitamin. An interview with the Diet Tech on September 24, 2013 at approximately 2:24 p.m. revealed the diet tech entered it into the system and may have forgotten to hit the save button. 5 During this time, the unit manager and the Registered Dietitian agreed the information was not in the system. 23. The unit manager reported, if the information was entered into the system and saved, it would have come to nursing for verification and the physician would be notified. During a further interview, the diet tech reported she was new at the facility and had been educated to ensure orders or recommendations are 'saved' in the system. 24. A further interview with the Registered Dietitian on September 26, 2013 revealed the new diet tech was using the new computer system and should have called the physician to see if he/she wanted the Multivitamin for the resident, then entered the information in the system and the nurse would have verified the order. 25, The Agency determined that this deficient practice 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. The Agency cited Respondent for a Class II deficiency as set forth in Section 400.23(8)(b), Florida Statutes (2013). 26. A Class I 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 I 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. 27. Based upon the above findings, the Respondent’s actions, inactions or conduct constituted an isolated Class II deficiency pursuant to Section 400.23(8)(b), Florida Statutes (2013). WHEREFORE, the Agency intends to impose an administrative fine in the amount of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500.00) against the Respondent pursuant to Sections 400.23(8)(b) and 400.102, Florida Statutes (2013). 6 COUNT II ; ; Assignment Of Conditional Licensure Status Pursuant To Section 400.23(7)(b), Florida Statutes (2013) 28. The Agency re-alleges and incorporates by reference the allegations in Count I. 29. The Agency is authorized to assign a conditional licensure status to skilled nursing facilities pursuant to Section 400.23(7), Florida Statutes (2013). 30. Due to the presence of one (1) Class Il deficiency, the Respondent was not in substantial compliance at the time of the survey with criteria established under Chapter 400, Part II, Florida Statutes (2013), or the rules adopted by the Agency. 31. The Agency assigned the Respondent conditional licensure status with an action effective date of September 26, 2013. The original certificate for the conditional license is attached as Exhibit A and is incorporated by reference. | 32. The Agency assigned the Respondent standard licensure status with an action effective date of October 26, 2013. The original certificate for the standard license is attached as Exhibit B and is incorporated by reference. . WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to enter a final order granting the Respondent conditional licensure status for the period beginning September 26, 2013 and ending on October 26, 2013 pursuant to Section 400.23(7)(b), Florida Statutes (2013). | CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests ihe Court to enter a final order granting the following relief against the Respondent as follows: _ 1. Make findings of fact and conclusions of law in favor of the Agency. 2. Impose an administrative fine against the Respondent in the amount of TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500.00.). 3. Assign conditional licensure status to the Respondent for the period beginning on 7 September 26, 2013, and ending on October 26, 2013. 4. Assess cosis related to the investigation and prosecution of this case. 5. Enter any other relief that this Court deems just van 30% cA _ Respectfully submitted this SC? day of 95 /__, 2014, ’ ao ( “le hovt CSc: ““Péborah E. Leoci, ‘Assistant Geheral ae sel Florida Bar No. 0814423 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (239) 335-1253 NOTICE - RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120. 57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/HE/SHE 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 AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 412-3630. THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form were served to: Gilda Anderson, Administrator, Delray Group, LLC db/a Lake View Care Center at Delray, 5430 Linton Boulevard, Delray Beach, Florida 33484, by | United ‘States Certified Mail, Return Receipt No. 7012 3460 0001 2195 3974 and to CT Corporation, Registered Agent, Delray Group, LLC d/b/a Lake View Care Center at Delray, 1200 South Pine Island Road, Suite 250, Plantation, Florida 33324, by United States Certified Mail, . . 4 hy Return Regsint Noy 7012 3460 0001 2195 3981 on this 30) ot day of 7. A 2014. Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (239) 335-1253 Copies furnished to: Gilda Anderson, Administrator Delray Group, LLC . d/b/a Lake View Care Center at Delra: 5430 Linton Boulevard Delray Beach, Florida 33484 (U.S. Certified Mail) Deborah E. Leoci, Assistant General Counsel Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 (Interoffice Mail) CT Corporation, Registered Agent Delray Group, LLC d/b/a Lake View Care Center at Delray 1200 South Pine Island Road, Suite 250 Plantation, Florida 33324 (U.S, Certified Mail) (Interoffice Mail) .| Bureau of Long Term Care Services Bernard Hudson, Health Services and a_i Facilities Consultant Supervisor Long Term Care Unit Agency for Health Care Administration 2727 Mahan Drive, Building #3, Room 1213B Tallahassee, Florida 32308 Arlene Mayo-Davis Field Office Manager. Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (Interoffice Mail) L_ . STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Re: Lake View Care Center at Delray Case No. 2013011707 ELECTION OF RIGHTS This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be an Administrative Complaint, Notice of Intent to Impose a Late Fee, or Notice of Intent to Impose a Late Fine. ' Your Election of Rights must be returned by mail or by fax within twenty-one (21) days of the date you receive the attached Administrative Complaint, Notice of Intent to Impose a Late Fee, or Notice of Intent to Impose a Late Fine. If your Election of Rights with your elected Option is not received by AHCA within twenty-one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a Final Order will be issued. Please use this form unless you, your attorney or your representative prefer to reply in accordance with Chapter 120, Florida Statutes (2013) and Rule 28, Florida Administrative Code. PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 Phone: 850-412-3630 Fax: 850-921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1)__—i._ admit the allegations of fact and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. I understand that by giving up my right to a hearing, a Final Order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. OPTION TWO (2) __ I admit the allegations of fact and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced. : OPTION THREE (3)__ I dispute the allegations of fact and law contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (3) by itself is NOT sufficient to obtain a formal hearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28- 106.2015, Florida Administrative Code, which requires that it contain: 1. Your name, address, telephone number, and the name, address, and telephone number of your representative or lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed action. 4. A statement of all disputed issues of material fact. If there are none, you must state that there are none. Mediation under Section 120,573, Florida Statutes may be available in this matter if the Agency agrees. License Type: (Assisted Living Facility, Nursing Home, Medical Equipment, Other) Licensee Name: License Number: Contact Person: Name Title Address: ‘ Street and Number City State Zip Code Telephone No. Fax No. E-Mail (optional) Thereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the above licensee. Signature: ; Date: Print Name: Title:

Docket for Case No: 14-004572