ce Ra a le, eee ree ar eens che ili he cb ADMINISTRATIVE, COMPLAINT YOu. ARE HEREBY NOTIFIED 4 that after twenty-one ( Part I, Florida Statutes. 2. Respondent, Wakulla Manor, is licensed by the Agency to operate & conan na rein ghoene at 4699 Crawfordville Highway, Crawfordville, Florida 32326.andis Q \ bligated to operate the nursing home in compliance with Chapter 400 Part 1, Florida ‘Statutes, and Rule 59A-4, Florida Administrative Code. On September 1-2, 1999, a Agency’ 5 axea 2 Office, During this follow-up survey, - “roerent was not met, speci ifica I a2 CFR R 5489 25(c). Brasoonsestth eh ZL /€ #ccegrecose : “9196 196: cog 21) days trom receipt of NOY; St wag noted that the following a w v) | AGENCY FOR Sea CARE ADMINISTRATION sy LE D Fe NATION pp aso tet Petitioner. "HES ave vs. AHCANO: 02-99-002-NHE(C) WAKULLA MANOR, got ag mL second follow-up survey was conducted by the “ONT 'SAILNGdONd DLV:AG LNAS (2) Based on the comprehensive assessment of a resident, the facility must ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. (b) Resident #7 was readmitted to the facility starus post right hip fracture on May 13, 1999. The initial nursing assessment revealed that the resident did not have any skin breakdown on either heel. The resident neither was identified sarcare planned for prevention. __ of pressure sores, even though the resident had very limited © mobility. A Braden Scale assessment was noted in the chart with a score of 1, indicating the resident was at risk for pressure sore development. lists the resident as having. wy a = black. pm. revealed that the facility hi pressure sores as of May 7, 1999. Due to stadt changes the log was not kept current and another log was not developed until August 17, 1999. ? (e) Based on observations, record reviews, and staff interview it was “determined that the facility cid not easure-that a-resident WWAO re mee “ enteted the facility without 4 pr@gsure sore did nd} develop oné for. 1 out of 8 sampled residents. 4. Tt was determined that Wakulla Manor had violated provisions of Chapter 400 Part II, Florida Statutes, and provisions of Rule 594-4, Florida Administrative Cade, for the aforementioned violation. 4, The above referenced violation constitutes grounds to levy this civil penalty pursuant to Section 400.23 and Section 400.141(8), Florida Statutes, and Rule L/P #:0ecspecoes “9T9E 196:S08 —-£ Q8:bT § 6G-02-01! “ONT “SAILNGdONd OLT:AG INAS 59A-4.1288, Florida Administrative Code, in that the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules, and regulations for the operation of a Nursing Home. NOTICE Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.57, Florida Stamutes, to be represented by counsel (at its expense), to take testimony, to call or cross-examine witnesses, to have subpoenas and/or : shea ; aah eld . . soe LPB ot O88 subpoenas duces tecum issued, and to present written evidence or ‘argument if it requests ' a hearing. Yn order to obtain a formal proceeding under Section 120.57(1), Florida Statutes, “Administration, Attention: R S. Power, Ageity Clerk, Senior Attomey, 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308- $403. Ce eee co All payment of fines sh ould be made by check, cashier’ s check, or money order and payable to the Agency for Health Care Administr@ion. ‘All ‘checks cashier rs checks, aa and money orders should identify the AHCA number and facility name that j is referenced { oo eke: on page 1 of this complaint. All payment of fines should be sent to the Agency for an - Health Care Administration, Attention: Christine T. Messana, Bsquire, General ‘Courtsel’s Office, 2727 Mahan Drive, ‘Building 3 3, Tallahassee, Florida 47308-5403. . : ey : an : ! ns ne eae Siviea aaah a 2 r ES “~ oe ef . 7 . . oa Se penne 7 . G #:! eesrecoge: “O19 186:908 : 2e:PE - 66- ~02- ne ONE ‘SAILYAdONd DLT: AG INAS L/9 #:8eegHez0ee “9198 196:908@ «: