STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION "STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No: 09-01-0104 NH Return Receipt Requested vs. 7000 1670 0011 4848 0517 : 7000 1670 0011 4848 0524 WHITEHALL BOCA LTD, d/b/a 7000 1670 0011 4848 0531 WHITEHALL BOCA RATON, Respondent / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Whitehall Boca LTD., d/b/a Whitehall Boca Raton (hereinafter “Whitehall Boca”) pursuant to 28-106.111, Florida Administrative Code (2000)(F.A.C.), and Chapter 120, Florida Statutes (“Fla. Stat.”) hereinafter alleges: NATURE OF ACTION 1. This is an action to impose an administrative fine in the amount of two thousand five hundred ($2,500) dollars pursuant to Section 400.23 Fla. Stat. JURISDICTION AND VENUE 2. This court has jurisdiction pursuant to Section 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. 3. Venue lies in Palm Beach County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207, F.A.C. Spr sepem PEE ee ie Ed lak a a POOR oF TE Sern oo é 5 PARTIES 4. AHCA is the enforcing authority with regard to nursing home licensure pursuant to Chapter 400, Part Il, Fla. Stat. and Rule 59A-4 F.A.C. 5. “Whitehall Boca” is a nursing home located at 7300 Del Prado South, Boca Raton, Florida 33433 and is licensed under Chapter 400, Part II, Fla. Stat., and Chapter 59A-4, F.A.C. . COUNT I WHITEHALL BOCA DID NOT ENSURE THAT RESIDENTS MAINTAIN ACCEPTABLE NUTRITIONAL PARAMETERS IN 2 OF 26 SAMPLED RESIDENTS. 400.022(1)() and 400..141(9), Fla. Stat., 483.25()(1), C.F.R., 59A-4.1288, F.A.C. (QUALITY OF CARE) Class II 6. AHCA realleges and incorporates (1) through (5) as if fully set forth herein. 7. Based on clinical record review, staff interview and direct observation, it was determined that the facility did not ensure that residents maintain acceptable nutritional parameters in 2 of 26 (resident #9 and #18) sampled residents who sustained a weight loss while residing in the facility. The findings include; 8. Resident ID #9 was admitted to the facility on 05/22/2000 with a diagnosis of stroke, pneumonia, Stage III pressure sore to the coccyx, hypothyroidism, urosepsis, diabetes, tracheostomy, ventilator dependent and percutaneous endoscopic gastrostomy (PEG) tube. Review of the clinical record revealed that the resident is dependent on enteral feeding to meet 100% of her nutritional needs. Review of the dietary notes revealed the resident's estimated needs to be 1830-2430 calories and 79-85 grams of protein per day. The current tube feeding, Glucerna 1/2 strength at 60cc/hr, provides only 690 calories and 29g of protein. The resident is being supplemented with a protein powder for an additional sop apprce sre Se ee rere TREE TT oe ek 10g of protein, for a total of 39 grams of protein. The resident is also noted to have a Stage TI wound on her Coccyx. 9. Review of the dietary note dated 6/29/01 states: "TF [tube feeding] restarted 1/2 strength Glucerna @60cc/hr, remains below estimated needs. POC [plan of care] discussed with NP [nurse practitioner] advance as tolerate. Continue to monitor." Review of the current tube feeding revealed that between 6/29/01 and 8/2/01 no changes or increases to the tube feeding had been made per the documented recommendations. Interview with the resident’s nurse on 7/31/01 revealed the resident is currently tolerating the tube feedings with no diarrhea or other problems. Review of the residents weight record revealed that between the first week of June and the last week of July the resident has lost 13 pounds (from 178 to 165 pounds). 10. Review of the clinical record revealed that between the dates of 5/23/00 and 6/26/01 there were 28 changes made to resident #9’s tube feeding, with no documentation that the resident’s estimated caloric needs were being met based on these changes. Interview with the nurse practitioner and the dietitian on 7/31/01 revealed that there have been problems managing the resident’s feeding due to various gastrointestinal problems. Review of the physician’s notes revealed that no gastroenterologist has seen the resident on consultation for over 1 year (last visit 7/28/00). 11. Further interview with the nurse practitioner on 7/31/01 revealed that she had no intentions of increasing or changing the enteral feeding to meet the needs of the resident. It was brought to the nurse practitioner's attention that the resident has had a 13- pound weight loss and was quoted as saying "have you seen the size of her." Additionally, ee SOTTO era i Ai A OE ET PET ORE ET RT PR TT TNE when questioned, about the amount of protein the resident was receiving, the practioner stated, "I should have doubled it." 12. Further interview with facility staff revealed that the resident’s spouse adamantly refuses Hospice care and wants everything to still be done for his spouse. 13. As of 8/2/01 the resident is still receiving 690 calories per day and 39 g of protein, with a non-healing Stage III pressure sore and no further interventions by facility staff have been implemented. . 14. _ Resident ID #18 was admitted to the facility with a diagnosis of pneumonia, dehydration, fever, atrial fibrillation, percutaneous endoscopic gastrostomy (PEG) feedings, and was noted to have a weight gain from 4/11/01 to 5/4/01 of 6 pounds (from 122 to 128 pounds). On 6/6/01, review of the clinical record revealed the resident had an additional 1.2 pounds weight gain (129 pounds). 15. Review of the clinical record revealed that on 6/12/01, the diet technician wrote a note stating the resident weighed "129 pounds (4.3% increase x 1 month), (8% increase x 90 days), (6.2% increase x 180 days)". 16. On 7/4/01, review of the weight record revealed the resident weighed 122 pounds, which reflects a 7 pounds weight loss. On 8/1/01, a review of the weight record revealed the resident weighed 120.8 pounds, reflecting an additional pound of weight loss for a total of an 8.2 pounds loss in 56 days (6.4 %). This resident’s usual body weight was documented in the clinical record as unknown. The ideal body weight for this resident was documented, in the 1/24/01 nutrition risk assessment completed after admission to the facility, as 128-156 pounds. This nutrition risk assessment also showed that the overall risk category as "high". A review of the dietary assessment dated 7/17/01, did not address the kl CELE OT CRS REE OTR ET ae 7 pounds weight loss. There was nothing in the clinical record to indicate this was a planned weight loss. In fact, there was no documentation in the dietary notes to address or explain the difference in weight. 17. On 08/01/2001, when the diet technician was questioned as to the sudden weight loss, she stated, "I don’t know what the problem is, I’m confused". 18. Based on the foregoing, “Whitehall. Boca” violated 400.022(1)() and 400.141(9), Fla. Stat., 59A-4.1288 F.A.C., 483.25(i)(1), C-F.R., herein classified as a Class II violation, which carries, in this case, an assessed fine of $2,500. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the Court to order the following relief: A. Enter a Judgment in favor of the Agency for Health Care Administration against “Whitehall Boca” on Count I. B. Assess against “Whitehall Boca” an administrative fine of $2,500 for the Class II violation in Count I, in accordance with Section 400.23(1)(b) Fla. Stat. C. Award the Agency for Health Care Administration reasonable attorney’s fees, expenses, and costs. D. Grant such other relief as the court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, semper were ror TED Srp paper es Manchester Building, First Floor, 8355 NW 53” Street, Miami, Florida 33166; Lourdes F. Roberts. . RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Steven P. Mulder, Administrator, Whitehall Boca Raton, 7300 Del Prado South, Boca Raton, Florida 33433, Whitehall Limited, Inc., 290 Coconut Avenue, Sarasota, Florida 34236, and to Robert Messick, Esquire, Registered Agent, Icard, Merril, Cullis, Timm, Furen & Gin, 2033 Main St., Suite 600, Sarasota, Florida 34230 this Bay of January, 2002. Agency for Health Care Administration 8355 NW 53™ Street Miami, Florida 3316 Copy to: Lourdes F. Roberts, Assistant General Counsel Agency for Health Care Administration Manchester Building 8355 NW 53" Street Miami, Florida 33166 Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 CE PRR “ARS RN SERRE Rp gee er Seo re ree Se reper oe eer reper crm is a Gloria Collins, Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, mail Stop #14 Tallahassee, Florida 32308 ik ' i TRS TE ree ie A As kad Mead a

Docket for Case No: 02-000674

Orders for Case No: 02-000674