Nov-14-2000 03:02pm = From-LEGAL AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ‘ADMINISTRATION, Petitioner, VS. 1-801-201-4801 7-375 -P.003/010 «F870 Og aan i gme F © Bove tee Sa NOV 21 PM &: Sa DIVi Siar: poe ADMINIS Rat HEAR STATE OF FLORIDA 00 PRAT) INGS ve QOUTSS AHCA NO; 10-00-078 NH BEVERLY ENTERPRISES-FLORIDA, INC., d/b/a BEVERLY GULF-CORPORATION, d/b/a WASHINGTON MANOR NURSING AND REHABILITATION CENTER, Respondent. ADMI / TRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that after twenty one (21) days from the receipt of this complaint, the Agency for Health Care Administration (hereinafter referred ta as the "Agency”) intends ta impose an administrative fine in the amount of Ten Thousand ($10,000) Dollars upon Beverly Enterprises-Florida, Inc., d/b/a Beverly Gulf- Corporation, W/b/a Washington Manor Nursing and Rehabilitation Center (hereinafter referred to as "Respendent”). As as follows: grounds for this administrative fine, the Agency alleges 1. The Agency has jurisdiction over Respondent by virtue of the provisions of Chapter 400, Part Il, Florida Statutes (Fla. Stat.) . 2. Respondent is licensed to operate at 4200 Washington Street, Hollywood, Florida 33021 as a nursing home in compliance with Chapter 400, Part I, (Fla. Stat.), and Chapter 59A-4, Florida Administranve Code (F.A.C.) 3. On oc about June 8, 20 00, as a result of a survey conducted by personnel from the office of the Agency for Health Care Administration it was found: Nov-14-2000 03:03pm. From-LEGAL 1-801-201-4801 T-375P.004/010 = F970 (a) Based on observation, interview and clinical and facility record review it was determined that the facility did not provide a safe and comfortable environment for one of thirty-two residents sampled. The findings were as follows: QQ) — Resident #10 was admitted on 02/12/98 with a diagnosis of dementia. Documentation reflects that on 5/29/00 at 12:50 am., 4 Certified Nursing Assistant (CNA) observed this resident in her bed and noted many ants crawling on the bed and on the resident. The staff pulled the sheets off and saw there were many more ants on the resident’s body from the waist up. The resident was mumbling and not very responsive. Vital signs were documented as blood pressure 110/70, pulse 70, respiration 20 and no distress noted. The resident was noted to have red blotches on the face, neck and upper body. The CNA reported ants were all over the curtain near the resident’s bed. The record documents the resident was washed and removed from the bed and placed into a geri-chair. The bed was stripped, the ants were killed, and the opening to the air conditioner was blocked. The other resident in the room was examined and no ants were noted. At 1:20 a.m, on 5/29/00, a-call was place to the physician’s service. At 2:55 a.m. a repeat call was placed to the physician’s service, At 3:15 am. and Advanced Registered Nurse Practitioner (ARNP) rerumed the call and a status reports was given. An order for Benadryl 50mg was received. The medication was documented as being given at 3:15 a.m. At 7 a.m. the) nurse’s notes reflect the resident was alert to name and verbally responsive. The right upper chest area was noted to have red blotches and a raised area with pustules. No distress noted. Bload pressure 120/80, pulse 72 and respiration 20. At 2:00 p.m. an entry in the nursing notes reflects the resident is lethargic but arousable. Red blotches with pusnules persist to right chest area, ight ann and back with no itching noted. The documentation reflects the ARNP saw the resident per nursing requests and the impression findings were: Herpes Zoster, Fluid and electrolyte imbalance. The orders ere: Zovirax 800 mg every four hanrs umes 7 days, give first dose today. Dermatology consult on|5/30/00 at 4:00 p.m. documentation reflects the resident 2 a aera an ee Nov-14=Z000 03:03pm = FromLEGAL 1-801-201-4801 T-375-P.005/0/0 F+870 was in bed with her eyes closed, respiration unlabored. Reddened area noted around resident’s mouth and on hand. Na signs of distress noted. Continue to momitor. At 9:30 am., on 5/30/00 the nurses notes reflects that the resident was observed with multiple clusters of pustules on upper chest, the full length of both arms, including fingers with the same on face. No scratching noted by resident, AT 9:45 a.m. nursing entry slates atiending physician saw resident and recommended transfer to haspisal for evaluation. At 10.05 a.m., the nurses notes reflect that a report was given to Adult Protective Services concerning the ant bites recorded on 5/29/00 with possible transfer to the hospital and that the exterminators will be here tdday. Resident awake and afousable, Art 10:30 a.m. documentation reflects the physician gave the order to transfer resident to acute care hospital for evaluation secondary and treatment secondary to ant bites. On 5/30/00 at 11:00 am. the resident was twansferred to an acute care hospital by the attending physician. The resident was admitted to the hospital on 5/30/00. The diagnosis recorded in the resident’s hospital record bie and bites, multiple sites; cellulitis, multiple sites and hypovolemia. The resident was treated and discharged to the facility on 6/30/00. In addition, during the review of the Adult Protective Services documentation, it was noted that the information reflected “hundred of ant bites and pustules were noted on the resident's body.” (2) Observation of the resident’s room and other rooms in the facility, (which was noted to be in the configuration of square with a “T” connected tw the square representing the facility’s south) wing) on 6/05/-08/00, revealed that there were gaps around the air conditioner units| sufficient to allow sunlight to shine through in rooms 201, 202, 207, 210, 222, 224, 300, 302, 303, 304, 305 and 306. The plaster on the west wall of room 221 was damaged with a space approximately 2 inches by 10 inches present. Tt is to be noted that resident #10) was in room 303. (3) The pest ¢ontrol contract and service records were requested and received an 06/07/00. The contract was determined to be in effect. The pest control 3 Nov-14-2000 03:03pm = From-LEGAL 1-501-201-4801 T7375 P.0N6/O10 = F-870 service was scheduled and completed twice monthly. Service records were examined and it was determined that ants were detected and treated on 4/13/00 in room 406 and the perimeter of the North and East sides of the building, Room 406 was again treated on 5/02/00, all roams on the 200 wing were treated for and infestation. Fire ants were detected coming “through the windows” in rooms 309, 409 and 428 and were killed. Again on 5/25/00, ants were treated in rooms 309, 310, 409 and 428. The recommendation on 5/25/00 was to trim tall tees. The pest control service treated rooms 302, 303 and 304 as well as the North and East sides of the building on 6/01/00 for ants. Again on 6/02/00, the service nested for ants in rooms 302, 303 and 304, as well as the North and East sides of the buildings as a “follow-up” to the work on 6/01/00. On 6/05/00, follow-up work was done in rooms 30}, 302, 303, 426, 427 and 428 with “no live activity found.” Bait placement was accomplished to “prevent future problems.” The recommendation on this date was: “Please have tees trimmed along East side of building, palms along courtyard. This will restrict access to building.” On 6/06/00, ghost ants were detected “coming through electrical sockets in dining” The pest control service person was interviewed by a surveyor on 6/07/00. The serviceperson stated that there were no ant problems on the intetior of the facility but that there were ongoing problems with insects on the exterior of the facility. A request was made for recards to determined the work done by the contracted landscape service. A leer from the Lawn Service dated 6/08/00 indicated that the “Arica Palms” on the East side of the building in the “cove” area were (rimmed on 6/06/00. |Trees and vegetation on the East sides of the building were also trimmed. Surveyor observations on 6/07/00 noted that rall wees on the East sides of the building remained jtouching and overhanging the roof of the East wing. Interview with facility staff on|6/07/00 indicates that in addition to the pest conmol program, a faciliry-wide quality improvement surveillance pragram is in place to monitor the presence of insects. Any evidence of infestation is to be reported to management so that measures can be taken to eliminate the problem. 4 Nov-14-2000 03:03pm | From=LEGAL 1-801-201-4801 7-378 = P.007/010 = F-870 This is in violation of rule 39A-4.1288, Class I deficiency. $10,000 Fine. 4. The abave referenced on constitute grounds to levy this administrative fine pursuant to Section 400.121, (Fla. Stat.), in that Respondent has violated the minimum standards, rules and regulations promulgated by the Agency under Chapter 400, Part If, (Fla. Stat.). Election of Rights attached to this Administrative Complaint. 6. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY ONE (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 | HEREBY CERTIFY that a tme copy hereof was sent by U.S. Centified Mail, Retum Receipt Requested, to Beverly Enterprises-Florida, Inc., 1000 Beverly Way, Fort Smith, AR 72919, Corporation Service Company, 1201 Hays street, Tallahassee, Florida. 32301, and to the Administrator,|Washington Manor Nursing and Rehabilitation Center, 4200 Washington Street, Hollywood, Florida 3302) on this 3Aay of Movewder/ , 2000. clan Kobe poke ney, Field Office Manager Agency for Health Care Administration 1400 W. Commercial Blvd., Suite 100 Ft. Lauderdale, Florida 33309 Copy to: Alba M. Rodriguez, Assistant General Counsel Agency for Health Care Administration Manchester Building, 1st Floor 8355 N.W. 53rd Street Miami, Florida 3316 Novleain 03:04pm | From-LEGAL 1-801-201-4801 T-375)— P.00B/O10 = F-970 Nursing Home Program Office Agency for Health Care Administration 2727 Mahan Drive ' Tallahassee, Florida 32308 Finance and Accounting Agency for Health Care Administstion 2727 Mahan Drive Tallahassee, Florida 32399

Docket for Case No: 00-004735

Orders for Case No: 00-004735