Bhar STATE OF FLORIDA 60 Ope 8 bag ~] AGENCY FOR HEALTH CARE ADMINISTRATION, PH 3: 35 DMP os AGENCY FOR HEALTH CARE Ne irae ADMINISTRATION, ALING SVE Petitioner, vs. AHCA NO: 10-00-074 NH BEVERLY ENTERPRISES-FLORIDA, INC., D/b/a BEVERLY GULF COAST-FLORIDA, LD -$Z OF INC., d/b/a WASHINGTON MANOR NURSING & REHABILITATION CENTER, Respondent. / ADMINISTRATIVE 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 to as the "Agency") intends to impose an administrative fine in the amount of Two Thousand Eight Hundred ($2,800) Dollars upon Beverly Enterprises-Florida, Inc., d/b/a Beverly Gulf Coast-Florida Inc., d/b/a Washington Manor Nursing & Rehabilitation Center (hereinafter referred to as "Respondent"). As grounds for this administrative fine, the Agency alleges as follows: 1. The Agency has jurisdiction over Respondent by virtue of the provisions of Chapter 400, Part II, Florida Statutes (F.S.) 2. Respondent is licensed to operate at 4200 Washington Street, Hollywood, Florida 33021, as a nursing home in compliance with Chapter 400, Part II, (F.S.), and Chapter 59A-4, Florida Administrative Code (F.A.C.) 3. From June 5-8, 2000, as a result of a survey conducted by personnel from the office of the Agency for Health Care Administration it was found: (a) The resident has the right to be free from any physical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms. Based on observation, record review, and interview with facility staff, it was determined that the facility did not ensure that 1 of 33 residents was free from physical restraints imposed for purposes of discipline or convenience. The findings include the following: (1) —_‘ During initial tour on 6/05/00 at 9:52 a.m., it was observed that Resident #28 had a mitt to the left hand. An inquiry was made by the surveyor to ascertain the reason for the use of the mitt, and the staff member on tour with surveyor reported that the mitt was to prevent the resident from the Gastrostomy tube (G-tube). (2) During record review on 6/07/00 at 10:00 a.m. the following entry was observed in a nurses note dated 6/02/00 at 9:00 a.m.: “Resident with mittens on both hands at spouse’s request. Spouse wants mitten on because she is fearful resident will go back to hospital if G-tube dislodge.” The following entry in the nurse’s notes, on 6/05/00 at 8:00 a.m.: “Resident with mittens on to prevent resident from pulling out G tube. Resident’s spouses request mittens, she is fearful resident will have to go back to hospital if he pulls G tube from stomach.” There was no documentation noted in the chart that the resident was assessed for the need of the mittens, a physician’s order or a care plan prior to the application of mittens to the resident. A physician’s order was also noted during this review. The order dated 6/05/00 at 10:15 p.m. documented the following: “Hand mittens to prevent pulling G-tube. Check visually Q 30 minutes, release Q 2 hours for exercise.” The findings were brought to the attention of the ADON. During interview with the ADON at 10:20 a.m., the nurses stated “The wife is very anxious and she wanted the mitt applied for safety, so that he won’t pull out the G-tube. (3) Further review of the clinical record did not result in documentation that the facility demonstrated the presence of a specific medical symptom 2 that would required the use of the mitt and how the use of the mitt would assist the resident in reaching his or her highest level of physical and psychosocial well-being. There was no documentation that the interdisciplinary team addressed the risk of decline at the time the mitt was applied. The care plan noted in the resident clinical record is dated 6/05/00. This is in violation of section 400.022(1)(0), (F.S.). Class III deficiency. This is in violation of section 400.022(1)(a), F.S. THIS IS A REPEAT DEFICIENCY FROM THE survey of 5/05/99. $700 Fine. (b) The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individually. Based on observation and interview, the facility did not promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity. The findings include the following: (1) During an interview with an unsampied resident on 6/06/00 at 9:00 a.m., it was revealed that this resident had placed his/her call light on at approximately 3 a.m. on 6/05/00 because he/she needed to urinate. According to this resident, no staff answered the call light for about 2 hours. After waiting approximately 2 hours, the resident had to begin to scream in order to get the attention of facility staff. The resident indicated that when the staff finally arrived to render assistance he/she had already urinated on him/herself. Further investigation and a review of this resident’s clinical record revealed an MDS dated 3/18/00, which indicated that, this resident has no cognitive impairments. (2) During the resident group interview conducted on 6/06/00 at 9:00 a.m./ it was revealed that 6 of 21 residents could not get assistance from staff unless that staff member has them on their assignment. Specifically, one resident indicated that he/she asks staff for assistance when his/her leg falls of the wheelchair’s leg rest. According to this resident he/she will ask a staff passing by for assistance, and staff will reply by saying, “You’re not my resident”. In addition, another resident indicated that he/she experience the same problem when he/she needs their diaper changed. According to this resident the staff tell the resident, You’re not on my assignment”, and leave them to sit in a wet diaper. This is in violation of section 400.022(1)(n), F.S. Class Il deficiency. $700 Fine. THIS IS A REPEAT DEFICIENCY FROM THE SURVEY OF 5/05/99. (c) The facility must store, prepare, distribute, and serve food under sanitary conditions. Based on observation was determined that the facility did not store, prepare, distribute, and serve food under sanitary conditions. During the sanitation tour of the dietary department conducted on 6/05/00, the following sanitation violations were noted: qd) The entry door of the walk-in-freezer did not close properly, which caused a heavy ice build up on the foods that were stored within the unit. It was determined that the non-fitting door could not properly control the temperature of the unit within the temperature requirements. (2) Leftover turkey and cheese slices were not properly labeled with a date. (3) Paper napkins, plastic silverware, and adaptive eating utensils were being stored within the mop room/chemical storage closet. (4) The rear exit door of the kitchen did not close tightly; leaving a gap to the outdoors that could allow the entrance of pests into the facility. (5) The rear wall of the kitchen was noted to be crumbling and had ~ loose fitting tiles. (6) Numerous ceiling vents and ceiling tiles that were located throughout food storage, dish room, and preparation areas were noted by rusted, molded, and with dust build up. (7) The temperature of the breaded fish patty located in the tray line steam tables did not meet the required minimal temperature of 140 degrees F. The temperature of the fish was recorded at 130 degrees F. (8) Cold foods were not kept refrigerated during the times that the line was in operation. The lunch dessert (apple slices) and the thickened juices were left out at room temperature while the line was in operation. (9) The walls, floors and doors of the main resident dining room were heavily soiled and in disrepair. This is in violation of section 400.141(9), F.S. Class III deficiency. $700 fine. THIS IS A REPEAT DEFICIENCY FORM THE SURVEY OF 5/05/99. (d) _A facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident. It was determined that the facility did not ensure that residents receive accurate, acquiring, and administration of medications ordered by the physicians to meet the needs of the residents. The findings include: (1) During clinical record reconciliation following a medication observation on 6/06/00 at 8:00 a.m., it was noted that the medication administration record for Resident #32 documented that the resident had been receiving 5 mg Coumadin p.o. on a daily basis since 4/10/00. During clinical record reconciliation, it was determined that the resident had a physician’s order dated 4/10/00 for Coumadin 2.5 mg qd p.o. Review of the Medication Administration Records (MAR) for this resident revealed that the order for Coumadin 2.5. mg had been transcribed as Coumadin 5 mg. On 5/24/00, an order was noted to “Hold Coumadin for 3 days” as a result of an abnormally high Prothrombin Time, (a laboratory test used to determine the effectiveness of blood thinners such as Coumadin). On 5/31/00, a physician’s order was noted to “restart Coumadin AO” )AO being used as an abbreviation for “as ordered”) The medication was restarted as Coumadin 5 mg p.o. qd. Review of the results of laboratory tests from 4/10/00 to 6/05/00 revealed frequent indications of Prothrombin Time levels above normal limits, sometimes indicated as “critical” levels. During that time, a Dental Consult” was indicated with a diagnosis of bleeding gums and “coagulapathy”, both possible indications for an abnormally high Prothrombin Time. Interview with the ADON and the DON revealed that the facility had transcribed and administered the wrong dose of Coumadin for this resident since 4/10/00. Interview with the Advanced RN Practitioner (ARNP) caring for this resident revealed that he/she was aware of the Prothrombin Time levels and the administration of 5 mg of Coumadin on a daily basis since 4/10/00. However, he/she did not feel that the double douse had been harmful to the resident. Following surveyor intervention, the ARNP wrote an order for “Coumadin 5 mg p.o. qd.” However, the resident had received the wrong dose of the medication for 69 days prior to the record review. (2) On 6/05/00, during the review of Resident #9 clinical record, it was observed that a Social Service note dated 3/20/00 specified “Pt. Was seen by a psychiatrist on the 15" day of March. She was diagnosed of depressive mood and put her on antidepressant Paxil 5 mg daily.” A psychiatrist consult contained in the record dated 3/15/00 was noted to specify, “Impression-Major Depression.” The recommendation noted was Paxil 5 mg Q am. An order for Paxil was transcribed 3/15/00 for Paxil 5 mg QD. Further review of the record revealed that the record did not contain any documentation to substantiate the administration of the medication as ordered. The MAR for 3/20/00 revealed that the medication was not administered for 15 days. The MAR contained documentation on 3/16, 3/17, 3/20, 3/22. 3/25 and 3/27, that the reason why Paxil 5 mg 1 tab was not given “not available, pharmacy called.” On 3/29 the reason specified for why the Paxil 5 mg was not administered was “Social Services working on financial status.” The Social Services’ note dated 3/20/00 specified that “The social worker had a long meeting with the resident to discuss with the usefulness of the medication. She agreed that she will take the medication and also pay for it.” Interview with the consultant pharmacist and clinical manager on 6/06/00 at 3:09 p.m. reported that she has to pull records to see why medications were not dispensed for resident #9 as to the computer states resident is “Label Only” which is why it may not have been dispensed “Label Only” is the category when medications are not sent to facility from pharmacy. The Resident may have never had medications sent to facility from pharmacy such as on the occasions when they are private pay, private insurance or HMO reimbursement. “If it is the first time request for medications for a patient, the pharmacy usually verifies payer source.” The DON specified in an interview on 6/07/00 at 2:27 p.m. that “the day shift nurses were the only ones aware of this and all they would have to d o was to call the pharmacy and me or the ADON would have given approval and they would have sent it. The day nurses tried to take care of it on their own and just work with Social Services.” The resident did not receive the ordered medication because of confusion regarding the payer status of the resident. (3) During the review of the MAR as it relates to the above example, it was observed that Megace was not administered to Resident #9 for 12 days. Review of the physician order sheet specifies an order on 3/17/00 for Megace oral susp 40 mg/ml 20 cc po QD. Documentation on the MAR dated 3/18/00 specifies that the reason the Megace was not administered was “not available, pharmacy called.” On 3/27/00, the MARA specifies “Megace 40 cc” as not given — social services working on financial status.” The resident did not receive the medication as ordered because confusion regarding the payer status of the resident. This is in violation of rule 59A-4.112(1), F.A.C. Class II] deficiency. $700 Fine. THIS IS REPEAT DEFICIENCY FROM THE SURVEY OF 5/05/99. 4. The above referenced violations constitute grounds to levy this administrative fine pursuant to Section 400.121, (F.S.), in that Respondent has violated the minimum standards, rules and regulations promulgated by the Agency under Chapter 400, Part I, @S.). All requests for hearings shall be made to: Agency for Health Care Administration Manchester Building, 1st Floor ‘ 8355 N.W. 53rd Street Miami, Florida 33166 Attention: Alba M. Rodriguez, Assistant General Counsel Payment of fines shall be made to: Agency for Health Care Administration P.O. Box 13749 Tallahassee, Florida 32317-3749 5. Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, (F.S.); to be represented by counsel (at its expense); to take testimony, to call and cross-examine witnesses, to have subpoenas and/or subpoenas duces tecum issued, and to present written evidence or argument if it requests a hearing. In order to obtain a formal proceeding, your request for an administrative hearing must conform to the requirements in Rule 28-106.201, (F.A.C.), and must state which issues of material fact you dispute. Failure to dispute material issues of fact in your request for a hearing may be treated by the Agency as an election by you of an informal proceeding under Section 120.57(2), (F.S.) 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. mea greet) I HEREBY CERTIFY that a true copy hereof was sent by U.S. Cetlifieg Mail, “ a . . / Return Receipt Requested to Administrator. Washington Manor Nursing, and Py Ky 35 ADighicicn ... Rehabilitation Center, 4200 Washington Street, Hollywood, Florida 33021, Coefbetsinn y we . 2D ily, Service Company, Registered Agent, 1201 Hays Street, Tallahassee, Florida 32301-25985 e and to Beverly Enterprises-Florida Inc., 1000 Beverly Way, Forth Smith, AR 72919 on this Pray of O ashe , 2000. Patritfa Feeney, Field Office Manager Agency for Health Care Administration 1400 West Commercial Blvd., Suite 100 Ft. Lauderdale, Florida 33309 Miami, Florida 33166 Copy to: Alba M. Rodriguez, Assistant General Counsel Agency for Health Care Administration Manchester Building, ist Floor 8355 N.W. 53rd Street Miami, Florida 3316 Nursing Home Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32399 NOTE: In accordance with the Americans with Disabilities Act, persons needing a special accommodation to participate in this proceeding should contact Alba M. Rodriguez no later than fourteen (14) days prior to the proceeding or hearing at which such special accommodation is required. Alba M. Rodriguez may be contacted at 8355 N.W. 53rd Street, Miami, Florida 33166. Telephone: (305) 499-2165 or 1-800-955-8770 (voice) via Florida Relay Service. .

Docket for Case No: 00-004809