: Received Event (Event Succeeded) Fa Date: 11/8/01 Time: 2:59 PM ‘Pages: 9 : : Sender: 850 413 9313 _ Remote este 0 443.9313 ' 208P0 483-28 Sees FOR HEALTH CARE AD 852 413 9313 P.23/09 AGENE: 1 » STATE OF FLORIDA, AGENCY FOR Ol 4 oF > - HEALTI CARE ADMINISTRATION, Fite Petitioner, ey v 3. ys. AHCA NO: 02-01 0114- nt 3} Py ah GULF COAST CONVALESCENT . Abra Sie OF CENTER, Rena Alive Respondent. } | ADMINY: AT ‘ YOU ARE HEREBY NOTIFIED that after rwenty-one (21) days from receipt of this Complaint, the State of Plonida, Agency for Health Care Administration (* Agency") intends to impose an adthiniswrative fine in the amount of $3, 006. 00 upen Gulf Coast Convalescent Center. As grounds for the impos ef this administrative fine, the Agency alleges as follows: 1. pes. . jurisdiction ever the Respondent pursuant to Chapter 400 lorida Scatuces.._ 2. Resptiient Gulf Coast Convalisrent Center, as licensed by ‘the Agency to opséatc a nursing home.a 997 Jenks Avenue, Panama cary, Florida : and is’ obligated ta “operate the nursing home in compliance with: Ghapter 400 Part I, Florida Stamures, and Rule 594-4, Florida Administrative Code. Bees a ee det es wom = Received Event (Event Succeeded) a ‘ peer renee Date: 11/8/01 Time: 2:59 PM Pages: 9 ; s 50 ‘ e ender: 850 413 9313 : : ; Remota@SH9~2a850 483.9313 AGENCY FOR HEALTH CARE AD 958 413 S313 P0409 : Sepylie-guer - vlagpm . : a \ “e easeee 3. on Maréi15. 2000 a survey team from the Agency's Area 2 Office conducted a, Survey and the following Class Il! deficiencies were | cited. | _ ga, Pursuant to 42 CFR §483.15(h)(1), the facility must provides safe, clean, comfortable, and homelike environment, allowing the use his or her personal belongings to the extent possible. resident to This cequirement was not met us evidenced by the following observations: 1) - During three (3) deys of the four (4) day survey, @ pervasivy strong urine oder was noted to permeate the Facility aA 9:30 a.m. on March 12, 2000, during the initial tour, strdihg urine odors were detected on the corridars of the « 100 h These odors were also detectable at the following QO am.; 1:30 p.m.; and 3:00 p.m. At 8:10 a.m. oe i mm. on March 13, 2000, strong oders were : Fhe 100 naliPaht.J@:30 am.qnMageh 1542000, |, s were detected an'the corridors 2004 aur. fe: * byild-up was obsérved tp be at prisroughaut the‘dacthiy and shalds of the.exdt ddérs also-were waganddit = we 3 the tour'of the shewers, a blood stained cotton : swah Was on rhe floor in the public area of the 100 hall ” shower. Wet discarded pads were observed on the floor of — - the shower in the 2006 hall. , ‘ ; as ae 4) Based on surveyor observations, interviews with staff and residents’ families, it was determined that the facility ; oo Volared..42 CFR 483,.15(h)(1), and Rule 59A-4,1288, Florida : Administrative Cade. for failing to provide a safe, clean, comfortable and homelike environment, (fag F252) , “Received Event (Event Succeeded) i oe me : : Date: 11/8/01 Time: 2:59 PM Pages: ; ; ° Ie 9 Sender: 850 413 9313 _ Remote Sia- 20860 483.9313 a Bo Sypv7-2001- Ois4zpm ce rom ae . ‘ ) controls, end prevents infections in the faciliry; decidcs what procedures, such as isolation, should be applied to an individual resident, and maintains a record of incidents and corrective actions related to inféctions.. This requirement was not met as evidenced by the following observations: 4} Resident #26 had a stage four (4) pressure Sore en coceyx. A wound culture report of Novernber 16, 1999 revealed ,that the resident's wound was infected with Methicellin Resistant Staph Aureus (MRSA). The physician's agsistant prescribed Vancomycin Antibintic Teatment via @ PICC Live insertion which..would provide far intravenaiis administration of the Vancomycin. However, staff auatced that the tesident refused to have the PJCC line inseruon. There was no dgocumentation that staff hud noufied the physiciantef the resident's refusal of the PICC bine. 2) ident had never been wie for the MRSA infecte d which hadygs@eressed bm" & Mixige.! te a stage 4 ‘a period of approximately three months. © ss ° 3) "waa no’ care plan for the MRSA infecion. The infectionwe tral log from November 1999 through February 2000: \Reked: identification, inveadigation, ¢ontral and prevention of the spread of the MRSA. 4) Based on: staff interviews and record reviews, it was determined that the facility’ violated 42 CFR §483.65(a}(1}-(3), and Rule S9A-4.1288, Florida Administrative Cade, for failing to ensure the investigate, control, and ‘prevent | infection.for one out of one: resident reviewed who had an infection: (Tag F441) 0° | * : IS 858 413 9313 _ P.e5v89 tee oo Received Event (Event Succeeded) Date: 11/8/01 Time: 2:59 PM Pages: 9 ; Sender: 850 413 9313 RASH -anBP0 443 9313 AGENCY FOR HEALTH CARE AD 2 Sapsl7-Z0s - Uis4sem reo } ] resident fo use bie or her personal belongings ta the extent possible. This requirement was mot met as evidenced by the following observations: ~ 1) Pervasive fecal and urine odors were nated on inital tour and subsequent days throughout the survey on ail the nursing units. , 2) Based on observation during the course of the survey, it was determined that the facility violated 42 CFR 483.15(h)(1], and Rule 59A-4.1288, Florida Admimstrative Code, for again failing to provide a safe, clean, cormfartable and homelike environment in that the environment Was not free frara objectionable odors. (TAL 252) 4B. 5 42 CFR §483.65{a)(1)-(3), the faciliry must establish an infectigg ‘control pragram under which it investigates. controls, and pre’ maintains a record of incidents and corrective actions related to infections. This requirement was not met as evidenced by the following observations: nuh ok 1) On January 22, 2001 at 12:10 pm. CST staff phserved in, the .main dining soare, moving ; sisting with : meals - with jfectians in the facility; decides what procedures, ih a nA i; ret euch as isolation, shauyld be’ applied ‘to’ arn individual resident; and ~ we is) perpen in : | 858 413 9313 ~- P.46/89 rt omen Tet : Received Event (Event Succeeded) Date: 11/8/01 Time: 2:59 PM rages: 9 Sender: 850 413 9313 ; ote RSID: on§P0 443.9313 AGENCY FOR HEALTH CARE AD ie _oSapeyre2aoy” 04:43am From- bin to dispose of the rowelette, thereafter proceeding to assist a resident. 4) On January 23, 2001 at 10:00 a.m. CST, it was observed there was na soap in the nurses’ bathroom on the north hall. S$} Based on observation, it was determined that the facility violated 42 CFR 483.65(a){1)-(3), and Rule 5¢A- 4.1288, Florida Administrative Code, for again failing to ensure the investigation, controls, and prevention of mifections and failing fe maintain good infecuon control practices, (Tag. ¥r441) 5. Based on the foregoing, Gulf Coast Convalescent Center has violated the following: . a. Tag F252 incorporates 42 CFR 483.15(h(1) and Rule 59A-4.1288, F.AC.; b. Tag F441 incorporates 42 CFR 483.65(a)(2)-(3) and * Rule 594-4.1288, F.A.C. ms : 6. The above referenced violations constitute grounds to levy this civil penalty pursuant to Section 400.23/8) and - Sectio wile S9A-4.1888, At es 400.102(1)(a\(d), Florida Starizes, ar Administrative Code, ia.that the above referenidied condtier: Sed cor ‘ie constitutes a violation ‘éfthesminy for the operation of a Nursing. Home. ‘Respondent is Bry eyed . Pot , eR administrative, hearing ‘pursidnt to Secti¢n 120. ites, to - - Lt cachet Loge bern Sarge |e be represented by course! § : to take testimoriy, tocall.or "| -. _ 858 413 $313 . P.07/09 cross-examine Witnesses, ta have subpoenas and/or, subpoenas. duces | i es eng gees Received Event (Event Succeeded) . oo - ms , 4 Date: 11/8/01 i Panes: 5 ume: 2:59 PM ‘ “Remo ender: 850 413 9313 RAS 2adP° 483.2315 AGENCY FOR HEALTH CARE AD 858 413 9313 P.@8/09 ) } ; we Sap-tZ-200) Ot:Adem "From tecur issued, and to present written evidence or argument if it requests ; a hearing. In order to obtain 2 formel proceeding under Section 120.57(1), an Florida Stanies, Respondent's request must state which issucs of material fact are disputed, Failure to dispute material issues of fact in the request for a4 hearing, indy be treated by the Agency as an election by Respondent for an informal proceeding under Section 120.57(2), Florida Starutes. All requests for hearing should be made to the Agency for we rmnee gett son F Health Care Administration, Attention: Diane Grubbs, Agency Clerk, ; 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308-5403. Au payment of fines should be made by check, cashier's check, or _¢ money order All checks, cas number and All payment ~ Administration, COMPLAINT * a ‘Sinem re commapt am 7 IT oF ALOE ate Received Event (Event Succeeded) Date: 11/8/01 Time: 2:59 PM Pages: 9 Sender: 850 413 9313 _ Remote SiR: andi? 483.8319 AGENCY FOR HEALTH CARE AD |, 859, 413 9313 | P.29/09 sSapthE2d0" Of s4dym Freee } a) y ¢ 2001. i Issued his J] Y day of ( a Lagu , | , . " oa) Heiherg t Field Office Manager, Area 2 Agency for Health Care Administration Health Quality Assurance ; 2727 Mahan Drive, Bidg. 2, MS#46 Tallahasgee, Florida 32303 CERTIFICATE OF SERVICE ] HEREBY CERTIFY that the original complaint was sent by U.S. “Mail Return Receipt Requested, ta: Administrator, Gulf Coast Convalescent Cent O37 Jenks. Averuie, Panama. City, Fl rida 32405 7 - ux Copies furnished toy “Christine T. Messana@' os . Senior Attorncy . = it ~~ Agency for Health Care. Administration {interoffice: mail) “Blizabeth Dudek, Peputy Secretary Managed Care and Health Quality = 5 ‘Agency for Health Care Administration ‘[interoffiee mail} TOTAL P.29 ee a emcee ee ar et

Docket for Case No: 01-004073