Oy STATE OF FLORIDA “ 5 AGENCY FOR HEALTH CARE ADMINISTRATION toy, . CT AGENCY FOR HEALTH CARE . “ey iy y a ADMINISTRATION, “he. Petitioner, 23s € vs. AHCA NO: 10-00-0799NH 22a Owe Zs 2 H.B.A. CORPORATION, d/b/a PLANTATION Loe NURSING & REHABILITATION CENTER, 5 ~ on 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 One Thousand Seven Hundred ($1,700) Dollars upon H.B.A. Corporation, d/b/a Plantation 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 Il, Florida Statutes (Fla.Stat.) 2. Respondent is licensed to operate at 4250 NW 5h Street, Plantation, Florida 33317 as a nursing home in compliance with Chapter 400, Part HI, (Fla.Stat.), and Chapter 59A-4, Florida Administrative Code (F.A.C.) 3. On or about 3/8-10/99, as a result of a survey conducted by personnel from the office of the Agency for Health Care Administration it was found: (a) Based on clinical record review and interviews, it was determined that the facility did not ensure that one out of 26 sampled residents received the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well being, in accordance with the comprehensive assessment and plan of care. The findings were as follows: (1) Resident #7 was admitted to the facility on 2/25/99 following an above the knee amputation of her left leg secondary to Osteomyelitis. The resident also had diagnoses of Insulin Dependent Diabetes, Left Cerebrovascular Accident With Right Hemiparesis and Aphasia, Depression, Anxiety with Agitation and a State II Decubitus of the Sacrum. Record review conducted on 3/09/99 at 9:30 a.m. showed that the resident was receiving Humulin 70/30 insulin, 84 units every morning at 6:30 a.m. and Humulin 70/30 units every evening at 4:30 p.m. A physician’s order dated 2/26/99 documented, “Call me if accucheck below 100 only and hold insulin if below 100.” (2) The accucheck for 3/05/99 at 6:30 a.m. was 90. The medication administration record documents that the insulin was given. There is no documentation in the clinical record that the physician was notified. An interview with a staff nurse on 3/09/99 revealed that the facility could not provide surveyor with documentation that the physician was ever notified of the low blood sugar. The accucheck for 3/06/99 at 6:30 a.m. was 75 and the accucheck for 3/06/99 at 4:30 p.m. was 77. In both instances on 3/06/99 it was documented on the accu check flow sheet, that juice was given. The physician was never called about the low blood sugars and the insulin was never held. The accucheck flowsheet documented in the section labeled “accucheck order” that the accucheck was to be done BID (twice a day)- call MD if <100 and hold insulin. (3) The physician made a visit on 3/08/99 and at that time documented that sugars on 2 occasions were below 100. The impression was tight diabetic control with hypoglycemia and the plan was to decrease the insulin dosage, which was decreased on 3/08/99. (4) The facility had not developed a resident care plan for management of diabetes, for example, watching for signs and symptoms of hypoglycemia especially since the resident was aphasic and could not verbalize symptoms of hypoglycemia. 2 (5) In summary, the physician made a visit on 3/08/99 and then decreased the insulin dosage which may have been decreased earlier had the physician been notified of the hypoglycemic episodes on 3/05/99 and 3/06/99. In addition, the facility did not develop a care plan sufficient to meet the needs of the this newly admitted resident prior to completion of the first comprehensive assessment and comprehensive care plan. This is in violation of rule 59A-4.1288, F.A.C. Class III deficiency. THIS IS A REPEAT DEFICIENCY FROM THE SURVEY OF 2/18/98. $850 Fine. (b) Based on record review, interview and observation, it was determined that the facility is not maintaining accurate medical records. The findings were: (1) | A review of resident #17’s record noted that the physician’s order sheet indicated that this resident is to receive a regular, nectar thick liquid diet. Further review of the dietary notes dated 12/14/98 and 3/04/99 also indicated a regular diet with nectar thick liquids. Observation of resident #17 during breakfast on 3/09/99 revealed that the resident was served orange juice, whole milk, and coffee. None of which had been thickened to nectar consistency. An interview with nursing and dietary staff determined that the diet with nectar thick liquids had been discontinued on 3/26/98 after a Speech Therapy evaluation determined that the resident no longer required the thickened liquids. The facility staff did not adjust the information to the clinical record to accurately reflect the correct diet. (2) On 3/9/99 at 9:30 a.m. a review of the clinical record for resident #7 revealed that the March physician’s order sheet documented that if the accucheck was below 120 call doctor and hold insulin. Further review of the record showed that on 2/26/99, the physician had changed the order to call if accucheck was below 100 only and hold insulin if below 100. The March physician’s order sheet and the medication administration sheet wee not updated to reflect the current orders. This is in violation of rule 59A-4.118(2), F.A.C. Class Il deficiency. THIS IS A REPEAT DEFICIENCY FORM THE SURVEY OF 2/18/98. $850 Fine. 4. The above referenced violations 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 II, Fla.Stat. FOR ELECTION OF RIGHTS SEE ATTACHED FORMS I HEREBY CERTIFY that a true copy hereof was sent by U.S. Certified Mail, Return Receipt Requested to Sheila J. Wiggins, Administration, Plantation Nursing and Rehabilitation Center, 4250 NW 5" Street, Plantation, Florida 33317, H.B.A. Corporation 5310 NW 337 Avenue, Suite 211, Ft. Lauderdale, Florida 33309-3319 on this Pray of Recember/ 200. by Certified Mail #s7000 0520 0016 7234 4025 and 7000 0520 0016 7234 4032. “4 Patricia Feeney, Field Office Manag Agency for Health Care Administration 1400 W. Commercial Blvd., Suite 100 Ft. Lauderdale, FL 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 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 STATE OF FLORIDA oF Me™ ey AGENCY FOR HEALTH CARE ADMINISTRATION Ay e NM, A 40, f Vy< 4 RE: CASE NAME. CASE NO. one Su, Me eng ELECTION OF RIGHTS Woe! Vos PLEASE SELECT ONLY 1 OF THE 3 OPTIONS An Explanation of Rights is attached. OPTION ONE (1) Q =I. do not dispute the allegations of fact contained in the Administrative Complaint and waive my right to object or to be heard. | understand that by waiving my rights, a final order will be issued that adopts the Administrative Complaint and imposes the sanctions sought. OPTION TWO (2) QI do not dispute and | admit the allegations of fact in the Administrative Complaint, but do wish to be afforded an informal proceeding, pursuant to Section 120.57(2), Florida Statutes, at which time | will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3) Q / do dispute the allegations of fact contained in the Administrative Complaint and request a formal hearing, pursuant to Section 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings. lf you choose OPTION THREE (3), in order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. In order to preserve your right to any hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Administrative Complaint. If you do not respond at all within twenty-one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint. If you have elected either OPTION TWO (2) or THREE (3) above and you are interested in discussing a settlement of this matter with the Agency, please also mark this block. Mediation under Section 120.573, Florida Statutes, is not available in this matter. SEND NO PAYMENT NOW -- REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL YOU RECEIVE A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES. (Please sign and fill in your current address.) Respondent (Licensee) Address: License. No. and facility type: Phone No. PLEASE RETURN YOUR COMPLETED FORM TO: [INSERT AREA ATTORNEY NAME AND _INFOJ], Agency for Health Care Administration, (Note: Overnight Deliveries to » FL 32308-5403.) Telephone Number: ; FAX ; TDD 1-800-955-8771. . ‘STATE OF FLORIDA My 5 AGENCY FOR HEALTH CARE ADMINISTRATION on <3 Py NOM Y ES, /: EXPLANATION OF RIGHTS UNDER SEC. 120.569, FLORIDA STATUTES WS 9, bes ARTA} (To be used in conjunction with Election of Rights form — attached) MGs Ve °s In response to the allegations set forth in the Administrative Complaint issued by the Agency for Health Care Administration (‘AHCA” or “Agency”), you must make one of the following elections within twenty-one (21) days from the date of receipt of the Administrative Complaint. Please make your election of the attached Election of Rights form and return it fully executed to the address listed on'the form. OPTION 1. If you do not dispute the allegations in the Administrative Complaint and waive your right to be heard, you should select OPTION 2 on the election of rights form. A final order will be entered finding you guilty of the violations charged and imposing the penalty sought in the Complaint. You will be provided a copy of the final order. OPTION 2. If you do not dispute any material fact alleged in the Administrative Complaint (you admit each of them), you may request an informal hearing pursuant to Section 120.57(2), Florida Statutes (1999) before the Agency. At the informal hearing, you will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal hearing, you should select OPTION 1 on the Election of Rights form. OPTION 3. If you dispute the allegations set forth in the Administrative Complaint (you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes (1999). To obtain a formal hearing, select OPTION 3 on the Election of Rights form. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. In order to preserve your right to a hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Administrative Complaint. If you do not respond at all within twenty-one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint. :

Docket for Case No: 01-000307