STATE OF FLORIDA . AGENCY FOR HEALTH CARE mina) 4 PH I: Ans! IS) OW C ~ STATE OF FLORIDA, AGENCY FOR Hi As pay HEALTH CARE ADMINISTRATION, EA BING lye gre Petitioner, vs. AHCA NO: 02-00-075-NH 0-002 8 PANAMA CITY NURSING CENTER, Respondent. / ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that after twenty-one (21) days from receipt of this Complaint, the State of Florida, Agency for Health Care Administration (“Agency”) intends to impose an administrative fine in the amount of $1,000.00 upon Panama City Nursing Center. As grounds for the imposition of this administrative fine, the Agency alleges as follows: 1. The Agency has jurisdiction over the Respondent pursuant to Chapter 400 Part II, Florida Statutes. 2. Respondent, Panama City Nursing Center, is licensed by the Agency to operate a nursing home at 924 West 13t Street, Panama City, Florida 32401 and is obligated to operate the nursing home in compliance with Chapter 400 Part II, Florida Statutes, and Rule 59A-4, Florida Administrative Code. 3. On October 7, 1999 a survey team from the Agency’s Area 2 Office conducted a survey and the following Class III deficiency was cited. 3A. Pursuant to 42 CFR 483.35(h)(2), the facility must store, prepare, distribute, and serve food under sanitary conditions. This requirement was not met as evidenced by the following observations: 1. The facility did not prepare and serve food under sanitary conditions in that they did not hold cold potentially hazardous foods at proper temperatures of at 41 degrees Fahrenheit or below. When food is not held at proper temperatures, harmful bacteria can grow, which could result in food borne iliness when consumed. The findings included: (a) During the lunch meal on October 5, 1999, at 11:45 a.m., the temperature of the banana pudding on the stainless steel cart was found to be 60 degrees Fahrenheit, fruit cocktail was found to be 50 degrees Fahrenheit, and the sugar-free Jell-O was 52 degrees Fahrenheit. The cold food items were not held in a manner to maintain a cold temperature. (b) During the evening meal on October 5, 1999, at 6:00 p.m., the temperature of the pureed egg salad sandwich which was placed in the steam table well filled with ice, was found to be 50 degrees Fahrenheit, and the regular egg salad sandwiches were found to be 50 degrees Fahrenheit. The sandwiches were not held in a manner to maintain a cold temperature. (c) During the lunch meal on October 6, 1999, at about 12:00 p.m., the temperature of the milkshake on the stainless steel cart was found to be 50 degrees Fahrenheit, and the temperature of the Ambrosia ‘dessert was found to be 67 degrees Fahrenheit. Although these food items were refrigerated before the tray line, they were not held in a manner to maintain a cold temperature. (d) During the breakfast meal on October 7, 1999, at about 7:55 a.m., the temperature of the orange juice on the stainless steel cart was found to be 54 degrees Fahrenheit. Although this food item was refrigerated before the tray line, it was not held in a manner to maintain a cold temperature. (e) The dietary management staff was informed of the temperatures at the time of these observations. 2. The facility did not prepare and serve food under sanitary conditions in that they did not hold hot potentially hazardous foods at proper temperatures of at 140 degrees Fahrenheit or above. When food is not held at proper temperatures, harmful bacteria can grow, which could result in food borne illness when consumed. The findings included: (a) During the lunch meal on October 5, 1999, at about 11:45 a.m., the temperature of the ham on the steam table was found to be 122 degrees Fahrenheit, the temperature of the pork on the steam table was found to be 130 degrees Fahrenheit, and the temperature of the pureed bread on the steam table was found to be 100 degrees Fahrenheit. (b) During the breakfast meal on October 7, 1999, at about 7:55 a.m., the temperature of the pureed scrambled eggs on the steam table was found to be 120 to 132 degrees Fahrenheit. (c) The dietary management staff was informed of the temperatures at the time of these observations. 3. The facility did not prepare and serve food under sanitary conditions in that they did not ensure that equipment food contact surfaces were properly washed, rinsed, and sanitized. All equipment food contact surfaces must be properly washed, rinsed and then sanitized, either using hot water or a chemical solution. When food is prepared and served on equipment which may be contaminated with harmful bacteria, the food can become contaminated as well, which could result in food borne illness when consumed. (a) During the tour of the kitchen on October 5, 1999, at about 9:20 a.m., it was observed that a chlorine-based sanitizer was used to sanitize pots and pans and other equipment in the three compartment sink. The dietary staff was asked if they had a kit or device to measure the concentration of the sanitizer to determine if it was the proper concentration to sanitize the pots and pans. The dietary staff stated that there were no test strips available. Also, there was no rinse water in the center sink compartment. (b) On October 6, 1999, the dietary staff produced test strips; however, these were for measuring the concentration of an iodine-based sanitizer. Again, there was no rinse water in the center sink compartment. (c) On October 7, 1999, the dietary staff produced the chlorine-based sanitizer test strips and the concentration was tested, and found to be acceptable. Again, there was no rinse water in the center sink compartment 4. During the tour of the kitchen on October 5, 1999, at about 9:20 a.m., the Hobart warewashing machine was observed to be operating, and the wash temperature peaked at 156 degrees Fahrenheit, instead of 160 degrees Fahrenheit, as specified on the machine. The sanitizing rinse water temperature was acceptable, at 182 to 184 degrees Fahrenheit. The dietary staff stated that they noticed the wash temperature of the machine did not reach 160 degrees Fahrenheit, yesterday, and maintenance staff was notified. However, the warewashing machine still needed additional repair work. The dietary staff did not execute any other alternative method to properly wash, rinse and sanitize dishes during this time. (a) On October 6, 1999, in the mid afternoon, the warewashing machine was finally repaired and the wash and rinse temperature both peaked at 180 degrees Fahrenheit. 5. The facility did not prepare and serve food under sanitary conditions in that they did not protect ready-to-eat food from cross-contamination from potential splatter of food wastes and water. When ready-to-eat food is not protected from cross-contamination from food wastes, water, or other foreign material, the ready-to-eat food may become contaminated with harmful bacteria, which could result in food borne illness when consumed. The findings included: 4. 6. (a) During the lunch meal on October 5, 1999, at about 11:45 a.m., it was observed by two surveyors that the staff were scraping food wastes from dishes during the same time that the tray line tray assembly was being conducted. There was no separation of the warewashing area to the food preparation and service area and was in very close proximity to the tray line. Food wastes, water and debris could be spattered on the resident's exposed plates of food and food contact surfaces on the tray line. (b) On October 6, 1999, it was observed that there were carts of ready-to-eat foods being served up and transported near the three compartment sink, simultaneously while pots and pans were being washed. There was no separation of the three compartment sink to the cold food preparation table and they were in very close proximity. Food wastes and water could be spattered on the exposed food and food contact surfaces during the preparation. Based on observation and staff interview, it was determined that the facility violated Rule 59A-4.1288, F.A.C., for failing to ensure proper handling of food and thorough cleaning and sanitization of utensils to protect against disease-causing organisms. On August 23, 2000 a survey team from the Agency’s Area 2 Office conducted a survey and the following repeat Class Ill deficiency was cited. 4A. Pursuant to 42 CFR 483.35(h)(2), the facility must store, prepare, distribute, and serve food under sanitary conditions. This requirement was not met as evidenced by the following observations: 1. On August 21, 2000 at 11:00 AM, a tray containing uncovered glasses with ice cubes was observed on top of a cart in the kitchen. The glasses remained uncovered for about 10 minutes, that is, for the duration of the initial kitchen tour. C c 2. On August 22, 2000 at 09:55 AM, a tray of uncovered glasses with ice were observed by the door and sink, and at 10:43 AM, 3 trays of glasses with tea were noted to have no - cover to protect against contamination. 3. During a tour of the kitchen on August 22, 2000 at 09:55 AM, a kitchen staff was observed cleaning the meat slicer. Examination of the slicer after cleaning found the equipment to have meat-like particles on the back surface of the blade. 4. Inspection of utensils on August 22, 2000 at 09:55 AM revealed the storage of food preparation utensils and dinnerware while still wet. At least 40 plates and 5 large baking pans, as well as 55 plate bottoms and 55 plate lids were observed to be stored wet. In addition to the potential risk of transferring residues from the dish washing process to foodstuffs, moisture and warmth (that results from stacking) can also support the growth of potentially harmful organisms. 5. A frying pan was observed hanging from a counter over the 3-compartment sink on August 22, 2000 at 11:35 AM. Close inspection of the pan revealed a fat-coated food- contact surface. When questioned whether the pan was stored dirty, the dietary manager indicated that spraying the pan with cooking fat was done to prevent the surface from rusting. In addition to defeating the purpose of cleaning and sanitizing the kitchenware to destroy harmful organisms, exposure of fats to air can affect their chemical composition and over time, result in rancidity. 6. Observation of the preparation of the sanitizing solution in the 3-compartment sink on 2 separate occasions by 2 different kitchen staff showed that the solution was not being prepared consistently. (a) On August 22, 2000 at 10:50 AM and again at 11:15 AM, 2 aides added different amounts of the sanitizer concentrate to the water. Accurate testing of the solution with a test strip was not achieved because according to the dietary manager, the test strip being used had fallen on the water previously. Determination of the actual concentration of the sanitizer, therefore, has not been possible as long as the tainted kit was being used. 7. Based on observation and staff interview, it was determined that the facility violated Rule 59A-4.1288, F.A.C., for again failing to ensure proper handling of food and thorough cleaning and sanitization of utensils to protect against disease-causing organisms. 5. Based on the foregoing, Panama City Nursing Center has violated the following: a) Tag F371 incorporates 42 CFR 483.35(h)(2) and Rule 59A-4.1288, F.A.C. The administrative fine imposed for this repeat violation is $1,000.00. 6. The above referenced violations constitute grounds to levy this civil penalty pursuant to Section 400.23(9)(c), Florida Statutes, 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 Statutes, to be represented by counsel (at its expense), to take testimony, to call or 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 under Section 120.57(1), Florida Statutes, Respondent’s request must state which issues of material fact are disputed. Failure to dispute material issues of fact in the request for a hearing, may be treated by the Agency as an election by C C Respondent for an informal proceeding under Section 120.57(2), Florida Statutes. All requests for hearing should be made to the Agency for Health Care Administration, Attention: Sam Power, Agency Clerk, Senior Attorney, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308. All payment of fines should be made by check, cashier’s check, or money order and payable to the Agency for Health Care Administration. All checks, cashier’s checks, and money orders should identify the AHCA . . number and facility name that is referenced on page 1 of this complaint. All payment of fines should be sent to the Agency for Health Care Administration, Attention: Christine T. Messana, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308-5403. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. \ Issued hig day of \ert>+m60, h- Heiberg Field Office Manager, Area #2 Agency for Health Care Administration Health Quality Assurance 2639 N. Monroe Street, Suite 208 Tallahassee, Florida 32303 ( C CERTIFICATE OF SERVICE I HEREBY CERTIFY that the original complaint was sent by U.S. Mail, Return Receipt Requested, to: Administrator, Panama City Nursing Center, 924 West 13% Street, Panama City, Florida 32401 on this 6 Cirday of _A\ysoewle, 2000. . Christine T. Messana, Esquire Office of the General Counsel Copies furnished to: Christine T. Messana Area 2 Office Attorney Agency for Health Care Gloria Collins, Finance & Accounting Administration 2727 Mahan Drive Mail Stop #3 Tallahassee, Florida 32308 Pete J. Buigas, Deputy Director Managed Care and Health Quality Agency for Health Care Administration 2727 Mahan Drive, Building 1 Tallahassee, Florida 32308-5403 U Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverag iuat x Postage qaat | 0 w we! Centtied Fee Retum Receipt Fee {Endorsement Required) Restricted Delivery Fee (Endorsement Required) (UU UbUU Uueb SENDER: 7 © Complete items 1 anc a additional services. Complete items 3, 4a, . D Print your name and address on the reverse of this form so that we can return this. card to you. Attach this form to the front of the mailpiece, or on the back if space does not OWrite "Retum Receipt Requestaa” on the mailpiece below the article number. 0 The Return Receipt will show to whom the article was delivered and the date delivered. 3. Article Addressed to: o 2 2 an 3 S g 2 < °o ao] =} 2 a E Administrator | Panama City Nursing Center 924 West 13" Street | Panama City, FL 32401 5 x 2 : (Print Name) eo vided) l also wieh to receive the follow- ing se: ) (for an extra fee): 1. O Addressee's Address 2. C1 Restricted Delivery 4a. Article Number Receipt Service. 4b. Service Type © Registered O Certified © Express Mait Olnsured O Retum Receipt for Merchandise [J COD 7 Date of Delivery 7 8. 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Docket for Case No: 01-000028