JA-1303 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION... Ue APR ~ fo AM 29 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. AHCA NO: 2001061341 08-01-0283-NH THE HEALTH CENTER OF NAPLES, INC., d/b/a THE ARISTOCRAT 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 The Health Center of Naples, Inc., d/b/a The Aristocrat, (hereinafter “Respondent” or “The Aristocrat”) and alleges: NATURE OF THE 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 (8) (b) Florida Statutes. Jurisdiction 2. The Agency has jurisdiction over the Respondent pursuant to Chapter 400, Part II, Florida Statutes. 3. Venue lies in Collier County, Division of Administrative Hearings, Pursuant to 120.57 Florida Statutes, and Chapter 28 F.A.C, Il, Florida Statutes and Rules S9A~4, Florida Administrative Code. 5. Respondent, The Aristocrat, is a nursing home located at 10949 Parny Street, Naples, Florida 34101. The facility is licenseg under Chapter 400, Part TI, Florida Statutes and Chapter S9A-4, Florida Administrative Code, 6. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 7. The facility was cited for the deficiency set eee 8. Based upon the Annual Health Licensure and Recertification Survey for a Skilled Nursing Facility conducted on or about October 8 through October 10, 2001, it was determined that the facility failed to adequately assess and develop a plan of care to maintain acceptable nutritional parameters for 1 (Resident #1) of 6 residents reviewed for nutritional concerns. This is evidenced by: 1) The facility failed to adequately assess and develop a Plan of care to prevent the resident from significant weight loss. 2) The facility failed to assess and develop adequate care plan after the resident had a significant weight loss of 5.3% of her body weight in less than 2 weeks, 3) The facility failed to adequately assess, evaluate and revise the care plan, to address the resident's risk for weight loss, after she had a significant weight loss of 9.93 in less than a month. The findings include: a. Resident #1 was admitted to the facility on 7/30/01 with diagnosis to include but not limited to Status Post (S/P) Left Hip Fracture, S/P Left Shoulder Fracture, Esophageal Reflux Disease, Osteoporosis, Pyloric Gastritis, and Depressive Disorder. a? ec SS ce sey snasasesssentans seen b. Review of the 5 Day Minimum Data Set (MDS) completed on 8/5/01 and the 14 day MDS completed 8/13/01, revealed she required extensive to total assistance with all Activities of Daily Living (ADL's) which includes eating. She is frequently incontinent of both bowel and bladder. The resident's cognitive skills for daily living was coded as modified independence. Further review of the MDS revealed that she was not exhibiting behavior problems. c. The resident weighed 136 lbs upon admission and is 60 inches tall. Review of the RAP (Resident Assessment Protocol) completed on 8/13/01, revealed she triggered for nutritional status. The RAP summary stated, "recent weight loss due to not eating 75%." d. Review of the resident's meal consumption for the month of August 2001, revealed that the resident's breakfast intake was approximately 443, Lunch 55% and Dinner was 43.5%. e. Review of the care plan developed on 8/15/01 Stated under problem, "weight concerns as related to: leaves 25% or more of food uneaten at most meals." The goal stated, "have increased food intake as evidenced by stable weight of 131." ‘The approaches included, "provide increased calories and or protein", eee eee ensnetene sana ene "diet as ordered" and "encourage good intake of diet, Supplements, fluid." f. Review of the dietary Progress notes lacked documentation indicating that calories and protein were increased to meet the resident's nutritional needs. g. Interview with the Dietary Manager (DM) on 10/9/01 at 3:10 P.M., revealed that they had changed the resident's diet on 8/6/01, from mechanical soft to regular consistency without a physician's order. h. Clinical record review lacked documentation that the resident received nutritional Supplements as specified in her care plan until 8/23/01. i. Review of resident's weight record revealed that she weighed 128.8 lbs on 8/11/01. This indicates a significant weight loss of 7.2 lbs or 5.3% of her total body weight since her admission on 7/30/01 (within a 12 day period). Clinical record review lacked documentation that indicated that a Registered loss. Furthermore there was no assessment of the resident's caloric and protein needs based on her current weight (128.8 lbs) and activity. lbs. This indicates a Significant weight loss of 13.5 these Supplements would Provide adequate Calories based on the resident's nutritional needs, 1. Further review of the dietary Progress notes weight loss, m. Interview with the Director of Nursing (DON) come out of her room. However, this is not Teflective in the tesident's comprehensive assessments that were 5S9A-4,.1288 F.A.C., adopting by reference 42 CFR 483.25 (g) (2), This is a Class If violation and the Agency is authorized to impose the fine amount of $2,500.00 Pursuant to Section 400.23 (8) (b) Florida Statutes. an administrative hearing Pursuant to Section 120.569, Florida Statutes, Specific options for administrative action are set out and explained in the attached Explanation of Rights (one Page) and Election of Rights (one page). All requests for hearing Shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 525 Mirror Lake Drive, St. Petersburg, Florida, 33701; Dennis L,. Godfrey, Senior Attorney. AGENCY. espectfully Submitted, nnis L. God rey Senior Attorney Agency for Health Care Administration FBN: 0158100 525 Mirror Lake Dr. St. Petersburg, FL 33701 (727) 552-1525 by U.S. Certified Mail Return Receipt No. 7001 2510 0007 5976 5605, to Corporation Service Company, Registered Agent for The Health Center of Naples, Inc., 1201 Hays Street, Tallahassee, FL 32301-2525, and by U.S, Mail, postage prepaid, to Mr. Derek Deeter, Administrator, The Aristocrat, 10949 Parnu Street, Naples, FL 34109 on this BT oy of March, 2002. nnis L. Godfrey Copies furnished to: Mr. Derek Deeter, Administrator The Aristocrat 10949 Parnu Street Naples, FL 34109 (U.S. Mail) Corporation Service Company Registered Agent for The Health Center of Naples, Inc. 1201 Hays Street Tallahassee, FL 32301-2525 (U.S. Certified Mail) Dennis L. Godfrey Senior Attorney Agency for Health Care Administration 525 Mirror Lake Dr. North Suite 310L St. Petersburg, FL 33701

Docket for Case No: 02-001303